摘要
目的 分析不同麻醉深度对老年患者术后认知功能障碍（POCD）发生率和血清S100 β蛋白水平的影响.方法 选取200例接受手术治疗的老年患者作为研究对象,将其随机分为浅麻醉组和深麻醉组各100例,浅麻醉组患者的术中Narcotrend麻醉深度指数（NTI）控制在47～64,深麻醉组患者术中的NTI控制在20～36.对两组患者的麻醉时间、手术时间、丙泊酚用量、瑞芬太尼用量、应用血管活性物质比例、术后视觉疼痛评分（VSA评分）、术中NTI、平均动脉压（MAP）、心率（HR）及术中、术后的血清S100-β蛋白水平进行观察和比较.结果 浅麻醉组患者的丙泊酚用量显著低于深麻醉组（t=3.024,P＜0.05）;两组患者术中各时点的MAP、HR差异均无统计学意义（t=0.083～0.968,均P＞0.05）;两组患者的麻醉时间、手术时间、瑞芬太尼用量、术后VSA评分、术中应用各类血管活性药物比例的差异均无统计学意义（χ^2=0.033～0.335,t=0.215～0.607,均P＞0.05.）;浅麻醉组患者的POCD发生率显著高于深麻醉组（χ^2 =19.888,P＜0.05）,从手术进行2小时时开始,两组患者的血清S100-β蛋白水平开始出现显著上升（q=2.945～4.557,P＜0.05）,深麻醉组患者的血清S100-β蛋白水平在术后24小时时恢复到麻醉前水平（q=0.308,P＞0.05）,而浅麻醉组患者的血清S100-β蛋白水平在术后24小时时仍高于麻醉前水平（q=3.256,P＜0.05）,而且从术毕时至术后24小时时,浅麻醉组患者的血清S100-β蛋白水平均高于深麻醉组（t=3.557～4.416,P＜0.05）.结论 在老年患者的手术中,应用较深麻醉深度可降低患者的POCD发生率和术后血清S100-β蛋白水平,有利于患者认识功能的恢复.
Objective To analyze the influence of different depth of anesthesia on the incidence of postoperative cognitive dysfunction （POCD） and the serum S100-β protein level of the elderly patients after operation. Methods 200 elderly patients treated with operation were selected as the research objects and randomly divided into the deeper anesthesia group and the lighter anesthesia group. 100 cases were included into each group. The Narcotrend anesthesia,depth index （NTI） of the patients in the lighter anesthesia group in the operation was maintained in 47-64, the NTI of the pa- tients in the deeper anesthesia group in the operation was maintained in 20-36. The anesthesia time, the operation time, the dosage of propofol, the dosage of remifentanil, the application ratio of vasoactive drugs, the postoperative visual ana logue score （VSA score）, the intraoperative NTI, mean arterial pressure （MAP）, heart rate （HR） as wel as the intraoperative and postoperative serum S100-β protein level of the patients in the two groups were observed and compared. Results The dosage of propofol of the patients in the lighter anesthesia group was significantly lower than that of the deeper anesthesia group （t = 3. 024, P〈0. 05）. At each intraoperative time point, the differences of MAP, H R of the pa tients between the two group were not statistically significant （t = 0. 083 -0. 968, P〉0.05）. There were no significant differences of the anesthesia time, the operation time, the dosage of remifentanil, the postoperative VSA score, the application ratios of various vasoactive drugs of the patients between the two groups（χ^2 = 0. 033-0. 335, t= 0. 215-0. 607, P〉0.05. ） ; The incidence of POCD in the patients in the lighter anesthesia group was significantly higher than that of the deeper anesthesia group （χ^2= 19. 888, P〈0.05）. From the time of 2h after the beginning of the operation, the serum S100-β protein level of the patients in the two groups began to rise significantly （q=2. 945-4. 557,
出处
《西部医学》
2015年第9期1352-1355,1358,共5页
Medical Journal of West China
基金
四川省中医药管理局中医药科学技术研究专项基金(2014B086)
关键词
老年
术后认知功能障碍
麻醉深度
S100-Β蛋白
血清学检测
Elderly
Postoperative cognitive dysfunction
Depth of anesthesia
S100-β protein
Serological detection
