摘要
目的探讨基于脑氧饱和度监测的麻醉管理在老年非小细胞肺癌(NSCLC)根治术中的应用效果及对患者认知功能的影响。方法选取2022年6月至2023年1月在华南理工大学附属第六医院治疗的老年NSCLC患者90例,采用信封法将患者分为观察组(n=45)和对照组(n=45),两组均在全身麻醉下行肺癌根治术,对照组给予常规麻醉管理,观察组给予基于脑氧饱和度监测的麻醉管理。观察两组手术时间、术中出血量、麻醉时间、瑞芬太尼用量及丙泊酚用量,同时比较两组血清白细胞介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)等差异。结果两组手术时间、术中出血量、麻醉时间和瑞芬太尼用量比较,差异均无统计学意义(均P>0.05);观察组丙泊酚用量为(880.41±41.06)mg,明显少于对照组(P<0.05)。观察组麻醉后5 min(T1)、麻醉后30 min(T2)时平均动脉压(MAP)和心率(HR)明显高于对照组(均P<0.05);观察组T1、T2和术毕(T3)时局部脑氧饱和度(rSO2)和脑电双频指数(BIS)明显高于对照组(均P<0.05)。观察组术后24 h的血清IL-6、CRP、PCT、肿瘤坏死因子α(TNF-α)和S-100b水平分别为(13.36±1.22)mg/L、(10.08±1.12)ng/L、(0.94±0.15)ng/ml、(11.15±1.26)ng/L和(1445.15±180.05)ng/L,明显低于对照组(均P<0.05)。观察组术后24 h的简易精神状态检查量表(MMSE)评分为(25.78±1.02)分,明显高于对照组(P<0.05)。观察组和对照组术后认知功能障碍发生率分别为4.44%(2/45)和8.89%(4/45),差异无统计学意义(P=0.673)。结论基于脑氧饱和度监测的麻醉管理在老年NSCLC根治术中有较好的应用效果,患者血流动力学指标波动小,可抑制炎症因子水平,对患者术后认知功能影响小。
Objective To explore the application effect of anesthesia management based on cerebral oxygen saturation monitoring in elderly non-small cell lung cancer(NSCLC)radical surgery and its impact on patient cognitive function.Methods Ninety elderly NSCLC patients who were treated at the Sixth Affiliated Hospital of South China University of Technology from June 2022 to January 2023 were selected.The patients were divided into an observation group(n=45)and a control group(n=45)using the envelope method.Both groups underwent radical lung cancer surgery under general anesthesia,while the control group received routine anesthesia management and the observation group received anesthesia management based on cerebral oxygen saturation monitoring.The surgical time,intraoperative blood loss,anesthesia time,remifentanil dosage,and propofol dosage were observed in two groups.At the same time,differences in serum interleukin-6(IL-6),C-reactive protein(CRP),procalcitonin(PCT),and other levels were compared between the two groups.Results There was no statistically significant difference in surgical time,intraoperative blood loss,anesthesia time,and remifentanil dosage between the two groups(all P>0.05);The dosage of propofol in the observation group was(880.41±41.06)mg,significantly lower than that in the control group(P<0.05).The mean arterial pressure(MAP)and heart rate(HR)in the observation group were significantly higher than those in the control group at 5 minutes(T1)and 30 minutes(T2)after anesthesia(all P<0.05);The local cerebral oxygen saturation(rSO2)and bispectral index(BIS)of the observation group at T1,T2,and postoperative(T3)were significantly higher than those of the control group(all P<0.05).The serum levels of IL-6,CRP,PCT,tumor necrosis factorα(TNF-α),and S-100b in the observation group at 24 hours postoperatively were(13.36±1.22)mg/L,(10.08±1.12)ng/L,(0.94±0.15)ng/ml,(11.15±1.26)ng/L,and(1445.15±180.05)ng/L,respectively,significantly lower than those in the control group(all P<0.05).The MMSE score of the o
作者
李其金
钟丽明
黎铨初
莫平
Li Qijin;Zhong Liming;Li Quanchu;Mo Ping(Department of Anesthesiology,the Sixth Affiliated Hospital,South China University of Technology,Foshan 528200,China;Nanhai Health Care School,Foshan 528200,China)
出处
《中国医师杂志》
CAS
2023年第12期1840-1844,共5页
Journal of Chinese Physician
基金
佛山市自筹类科技计划项目(2220001005663)。
关键词
癌
非小细胞肺
肺外科手术
脑氧饱和度
麻醉
认知
Carcinoma,non-small-cell lung
Pulmonary surgical procedures
Cerebral regional oxygen saturation
Anesthesia
Cognition
