浙江医学
浙江醫學
절강의학
ZHEJIANG MEDICAL JOURNAL
2014年
19期
1622-1625
,共4页
脑状态指数%老年患者%妇科手术%麻醉%术后认知功能障碍
腦狀態指數%老年患者%婦科手術%痳醉%術後認知功能障礙
뇌상태지수%노년환자%부과수술%마취%술후인지공능장애
Cerebral%State Index%Elderly patients%Gynecological surgery%Anesthesia%Postoperative cognitive dysfunction
目的：探讨脑状态指数（CSI）监测对预防老年妇科患者术后认知功能障碍（POCD）的作用。方法将60例择期老年妇科手术患者按随机数字表法分为两组，每组各30例，A组术中在CSI监测下调整丙泊酚剂量以维持CSI在40～60，B组由固定的高年资麻醉医师凭经验调控麻醉。记录诱导前（T1）、气管插管（T2）、切皮（T3）、手术标本切下（T4）、手术结束（T5）、回病房（T6）等各时点SpO2、MAP、HR值。记录两组患者异丙酚、顺苯磺酸阿曲库铵用量及麻黄碱、阿托品用药次数及麻醉恢复情况；并于麻醉前、应答后1、6h和1、3d采用简易精神状态量表（MMSE）评价认知功能。结果 A组MAP T4时点高于B组（P＜0.01），其余时点差异均无统计学意义（均P＞0.05）；A组异丙酚用量以及麻黄碱、阿托品用药次数均明显少于B组（均P＜0.01）；A组应答时间少于B组（P＜0.05）；两组患者应答后1h MMSE评分较麻醉前均下降，A组应答后6h时MMSE评分下降的幅度低于B组（P＜0.05），其余各时间段MMSE评分均属正常。结论 CSI可以作为老年妇科手术患者麻醉深度监测的一个重要指标，有利于减少POCD的发生。
目的：探討腦狀態指數（CSI）鑑測對預防老年婦科患者術後認知功能障礙（POCD）的作用。方法將60例擇期老年婦科手術患者按隨機數字錶法分為兩組，每組各30例，A組術中在CSI鑑測下調整丙泊酚劑量以維持CSI在40～60，B組由固定的高年資痳醉醫師憑經驗調控痳醉。記錄誘導前（T1）、氣管插管（T2）、切皮（T3）、手術標本切下（T4）、手術結束（T5）、迴病房（T6）等各時點SpO2、MAP、HR值。記錄兩組患者異丙酚、順苯磺痠阿麯庫銨用量及痳黃堿、阿託品用藥次數及痳醉恢複情況；併于痳醉前、應答後1、6h和1、3d採用簡易精神狀態量錶（MMSE）評價認知功能。結果 A組MAP T4時點高于B組（P＜0.01），其餘時點差異均無統計學意義（均P＞0.05）；A組異丙酚用量以及痳黃堿、阿託品用藥次數均明顯少于B組（均P＜0.01）；A組應答時間少于B組（P＜0.05）；兩組患者應答後1h MMSE評分較痳醉前均下降，A組應答後6h時MMSE評分下降的幅度低于B組（P＜0.05），其餘各時間段MMSE評分均屬正常。結論 CSI可以作為老年婦科手術患者痳醉深度鑑測的一箇重要指標，有利于減少POCD的髮生。
목적：탐토뇌상태지수（CSI）감측대예방노년부과환자술후인지공능장애（POCD）적작용。방법장60례택기노년부과수술환자안수궤수자표법분위량조，매조각30례，A조술중재CSI감측하조정병박분제량이유지CSI재40～60，B조유고정적고년자마취의사빙경험조공마취。기록유도전（T1）、기관삽관（T2）、절피（T3）、수술표본절하（T4）、수술결속（T5）、회병방（T6）등각시점SpO2、MAP、HR치。기록량조환자이병분、순분광산아곡고안용량급마황감、아탁품용약차수급마취회복정황；병우마취전、응답후1、6h화1、3d채용간역정신상태량표（MMSE）평개인지공능。결과 A조MAP T4시점고우B조（P＜0.01），기여시점차이균무통계학의의（균P＞0.05）；A조이병분용량이급마황감、아탁품용약차수균명현소우B조（균P＜0.01）；A조응답시간소우B조（P＜0.05）；량조환자응답후1h MMSE평분교마취전균하강，A조응답후6h시MMSE평분하강적폭도저우B조（P＜0.05），기여각시간단MMSE평분균속정상。결론 CSI가이작위노년부과수술환자마취심도감측적일개중요지표，유리우감소POCD적발생。
Objective To investigate the effect of Cerebral State Index (CSI) monitoring on reducing the morbidity of postoperative cognitive dysfunction (POCD) in elderly patients with gynecological operation. Methods Sixty elderly patients scheduled for elective gynecological surgery were randomly divided into two groups with 30 in each group. Patients in group A were anesthetized by adjusting the doses of propofol to maintain CSI values in the range of 40 ~60; patients in group B were anesthetized by the experienced anesthesiologists without monitoring CSI. The SpO2, MAP, HR values were recorded before in-duction (T1), at endotracheal intubation (T2), skin incision (T3), surgical specimens cut (T4), the end of surgery (T5) and back to the ward (T6). The total dosages of propofol and atracurium cisatracurium, the frequencies of ephedrine and atropine administration and recovery time were observed and documented. The mini- mental state examination (MMSE) scores were used to assess the cognitive function at pre- anesthesia, and 1 h, 6 h, 1 d, 3 d after consciousness- recovered. Results The MAP of the group A was significantly higher than that of group B at T4(P<0.01), and there was no significant difference at other time point(P>0.05). The total dosages of propofol, and the frequencies of ephedrine and atropine administration were significantly decreased in the group A (P<0.01). The times of opening eyes and extubation were similar between two groups (P>0.05). Between two groups, MMSE score was significantly decreased 1h after recover of consciousness compared to the baseline score before anesthesia. At 6 h after recover of consciousness, the decrease of MMSE score in group A was less than that in group B (P<0.05). Conclu-sion CSI can be considered as a vital indicator for monitoring the depth of anesthesia, which is benefit for decreasing the inci-dence of POCD in elderly patients with gynecological surgery.
