CAJ | 학술논문

目的评价老年患者围术期脑功能状态定量监测特征及其与术后认知功能障碍(POCD)的关系.方法拟于全身麻醉下行腰椎减压融合术患者70例,年龄≥60岁,ASA分级Ⅰ或Ⅱ级,预计术后住院时间≥7d,术前简易智能精神状态检查量表测试结果正常.同时选择50名老年健康志愿者作为对照.于术前1天(D0)、术后第3天(D3)、术后第7天(D7)时评估认知功能,以Z计分法诊断POCD的发生,根据是否诊断为POCD分别纳入POCD组或对照组(C组).使用脑电定量监控牵引系统行脑功能状态定量监测,记录小波指数(WLI)、内专注指数(i_22)、脑活性指数(i_20).结果 67例患者完成试验并纳入分析,C组9例,POCD组58例.与D0时比较,D7时WLI降低(P＜0.05),D3时WLI差异无统计学意义(P＞0.05);与D3时比较,D7时WLI降低(P＜0.05),3个时点i_22、i_20差异无统计学意义(P＞0.05).与C组比较,POCD组D0时i_22降低(P＜0.05),其他时点i_22、各时点WLI、i_20差异无统计学意义(P＞0.05).结论老年患者围术期脑功能状态定量监测中,WLI于术后第7天明显降低,i_20、i_22无明显变化;而术前低i_22值可能可预测POCD的发生.
목적 평개노년환자위술기뇌공능상태정량감측특정급기여술후인지공능장애(POCD)적관계.방법 의우전신마취하행요추감압융합술환자70례,년령≥60세,ASA분급Ⅰ혹Ⅱ급,예계술후주원시간≥7d,술전간역지능정신상태검사량표측시결과정상.동시선택50명노년건강지원자작위대조.우술전1천(D0)、술후제3천(D3)、술후제7천(D7)시평고인지공능,이Z계분법진단POCD적발생,근거시부진단위POCD분별납입POCD조혹대조조(C조).사용뇌전정량감공견인계통행뇌공능상태정량감측,기록소파지수(WLI)、내전주지수(i_22)、뇌활성지수(i_20).결과 67례환자완성시험병납입분석,C조9례,POCD조58례.여D0시비교,D7시WLI강저(P＜0.05),D3시WLI차이무통계학의의(P＞0.05);여D3시비교,D7시WLI강저(P＜0.05),3개시점i_22、i_20차이무통계학의의(P＞0.05).여C조비교,POCD조D0시i_22강저(P＜0.05),기타시점i_22、각시점WLI、i_20차이무통계학의의(P＞0.05).결론 노년환자위술기뇌공능상태정량감측중,WLI우술후제7천명현강저,i_20、i_22무명현변화;이술전저i_22치가능가예측POCD적발생.
Objective To evaluate the characteristics of quantitative monitoring of brain function during the perioperative period in elderly patients and its relationship with postoperative cognitive dysfunction (POCD).Methods Seventy ASA physical status Ⅰ or Ⅱ patients,aged ≥ 60 yr,scheduled for elective lumbar spine decompression and fusion surgery under general anesthesia,having an expected postoperative length of hospital stay ≥ 7 days,were enrolled in the study.The cognitive function was assessed by using Mini-Mental State Examination before operation and the results were normal.Fifty healthy elderly volunteers were chosen and served as control group.Cognitive function was assessed at l day before operation (D0) and 3 (D3) and 7 days after operation (D7).Z score was used to identify POCD.All the patients were then divided into POCD group or control group (group C) according to the results of diagnosis.Quantitative monitoring of brain function was carried out using a traction system,and the wavelet index (WLI),i_22 and i_20 were recorded.Results A total of 67 patients completed the study and were enrolled in the analysis,there were 9 cases in group C,and 58 cases in group POCD.The WLI was significantly decreased at D7,and no significant change was found in WLI at D3 as compared with the value at D0.The WLI was significantly lower at D7 than at D3.There was no significant difference in i_22 and i_20 between the three time points.Compared with group C,i_22 was significantly decreased at D0,and no significant change was found in i_22 at the other time points and in WLI at each time point in POCD group.Conclusion During quantitative monitoring of brain function during the perioperative period in the elderly patients,WLI is significantly decreased on 7th day postoperatively,and no significant change is found in i_20 and i_22,however,the pre-operative low i_22 value can predict the development of POCD.