全科医学临床与教育
全科醫學臨床與教育
전과의학림상여교육
CLINICAL EDUCATION OF GENERAL PRACTICE
2014年
4期
392-394
,共3页
麻醉%腹腔镜胆囊切除术%脑电双频指数%认知功能%应激反应
痳醉%腹腔鏡膽囊切除術%腦電雙頻指數%認知功能%應激反應
마취%복강경담낭절제술%뇌전쌍빈지수%인지공능%응격반응
anesthesia%laparoscopic cholecystectomy%bispectral index%cognition function%stress reaction
目的：探讨不同麻醉深度对腹腔镜胆囊切除术老年患者认知功能及应激反应的影响。方法70例老年腹腔镜胆囊切除术患者随机分为两组，每组35例。脑电双频指数（BIS）监测麻醉深度，A组维持术中BIS在50~59，B组40~49。采用简易精神状态量表（MMSE）评估患者术前24 h、拔管后1 h、3 h和24 h的认识功能，并于麻醉前、切皮前、胆囊切除时、拔管后30 min检测患者血清皮质醇（Cor）、血糖（Glu）浓度和C-反应蛋白（CRP）水平。结果两组患者各时间点MMSE评分比较，差异均无统计学意义（t分别=0.41、0.15、0.43， P均＞0.05）；麻醉前两组患者Cor、Glu和CRP水平比较，差异均无统计学意义（t分别=0.37、0.24、0.04，P均＞0.05），但B组患者麻醉后各时间点Cor、Glu和CRP水平均低于A组麻醉后，差异均有统计学意义（t分别=3.87、4.54、3.61、2.47、3.17、3.36、3.65、5.65、6.63，P均＜0.05）。结论维持术中BIS在50~59和40~49对腹腔镜胆囊切除术老年患者认知功能的影响相当，但后者对应激反应抑制效果更好。
目的：探討不同痳醉深度對腹腔鏡膽囊切除術老年患者認知功能及應激反應的影響。方法70例老年腹腔鏡膽囊切除術患者隨機分為兩組，每組35例。腦電雙頻指數（BIS）鑑測痳醉深度，A組維持術中BIS在50~59，B組40~49。採用簡易精神狀態量錶（MMSE）評估患者術前24 h、拔管後1 h、3 h和24 h的認識功能，併于痳醉前、切皮前、膽囊切除時、拔管後30 min檢測患者血清皮質醇（Cor）、血糖（Glu）濃度和C-反應蛋白（CRP）水平。結果兩組患者各時間點MMSE評分比較，差異均無統計學意義（t分彆=0.41、0.15、0.43， P均＞0.05）；痳醉前兩組患者Cor、Glu和CRP水平比較，差異均無統計學意義（t分彆=0.37、0.24、0.04，P均＞0.05），但B組患者痳醉後各時間點Cor、Glu和CRP水平均低于A組痳醉後，差異均有統計學意義（t分彆=3.87、4.54、3.61、2.47、3.17、3.36、3.65、5.65、6.63，P均＜0.05）。結論維持術中BIS在50~59和40~49對腹腔鏡膽囊切除術老年患者認知功能的影響相噹，但後者對應激反應抑製效果更好。
목적：탐토불동마취심도대복강경담낭절제술노년환자인지공능급응격반응적영향。방법70례노년복강경담낭절제술환자수궤분위량조，매조35례。뇌전쌍빈지수（BIS）감측마취심도，A조유지술중BIS재50~59，B조40~49。채용간역정신상태량표（MMSE）평고환자술전24 h、발관후1 h、3 h화24 h적인식공능，병우마취전、절피전、담낭절제시、발관후30 min검측환자혈청피질순（Cor）、혈당（Glu）농도화C-반응단백（CRP）수평。결과량조환자각시간점MMSE평분비교，차이균무통계학의의（t분별=0.41、0.15、0.43， P균＞0.05）；마취전량조환자Cor、Glu화CRP수평비교，차이균무통계학의의（t분별=0.37、0.24、0.04，P균＞0.05），단B조환자마취후각시간점Cor、Glu화CRP수평균저우A조마취후，차이균유통계학의의（t분별=3.87、4.54、3.61、2.47、3.17、3.36、3.65、5.65、6.63，P균＜0.05）。결론유지술중BIS재50~59화40~49대복강경담낭절제술노년환자인지공능적영향상당，단후자대응격반응억제효과경호。
Objective To explore the effect of different depth of anesthesia on cognition function and stress reaction in elders with laparoscopic cholecystectomy. Methods A total of 70 cases of elderly with laparoscopic cholecystectomy were randomly divided into two groups with 35 cases each. The depth of anesthesia was detected by bispectral index(BIS),and the BIS values were maintaining 50 to 59 in group A and 40 to 49 in group B respectively. Cognitive functions at 24 hours before operarion,3 hours and 24 hours after extubation were evaluated by the minimum mental state examination (MMSE) scale. The serum levels of cortisol(Cor), glucose(Glu) and C-reaction protein(CRP) were detected at the times of begin-ning of anesthesia, skin incision, gallbladder removaling and 30 minutes after extubation. Results The MMSE scores showed no statistical difference between the two groups at every point (t=0.41,0.15,0.43, P>0.05). The level of Cor, Glu and CRP at beginning of anesthesia between two groups were not significantly different(t=0.37, 0.24,0.04, P>0.05), but those in group B were lower than group A at times of skin incision, gallbladder removaling and 30 minutes after extubation (t=3.87, 4.54, 3.61, 2.47, 3.17, 3.36, 3.65, 5.65, 6.63, P<0.05). Conclusion The effect of maintaining BIS at 50 to 59 and 40 to 49 were similar on cognitive function in elders with laparoscopic cholecystectomy,but the latter for inhibiting stress reaction was better.
