CAJ | 학술논문

目的：探讨不同麻醉深度对老年患者腹腔镜胆囊术后认知功能障碍的影响。方法选取本院2011年10月至2013年12月行腹腔镜胆囊手术治疗的老年患者94例，均采用脑电双频指数（BIS ）监测麻醉深度。采用随机数字表法分为2组，47例患者术中BIS维持在50～59为对照组，47例患者术中BIS维持在40～49为观察组，采用简易精神状态量表（MMSE）评定患者的认知功能，比较2组患者不同时间点（术前、拔管1 h、拔管3h、术后1d、术后3d、术后7d）的认知功能情况、苏醒情况、拔管情况、手术前后相关指标（同型半胱氨酸、缺氧诱导因子‐1α）的改变情况。结果观察组患者在拔管1 h、拔管3 h时MMSE评分均明显低于对照组。观察组患者苏醒时间、拔管时间、定向力恢复时间均明显晚于对照组。观察组患者在切皮前、胆囊切除时、拔管30 m in时相关指标（同型半胱氨酸、缺氧诱导因子‐1α）均明显低于对照组，差异均有统计学意义（ P ＜0.05）。结论术中BIS维持在40～49时，对老年患者腹腔镜胆囊术后早期的认知功能障碍影响较大，随后逐渐恢复至正常水平，能够造成苏醒延迟，对同型半胱氨酸、缺氧诱导因子‐1α具有较好的抑制效果，值得临床推广使用。
목적：탐토불동마취심도대노년환자복강경담낭술후인지공능장애적영향。방법선취본원2011년10월지2013년12월행복강경담낭수술치료적노년환자94례，균채용뇌전쌍빈지수（BIS ）감측마취심도。채용수궤수자표법분위2조，47례환자술중BIS유지재50～59위대조조，47례환자술중BIS유지재40～49위관찰조，채용간역정신상태량표（MMSE）평정환자적인지공능，비교2조환자불동시간점（술전、발관1 h、발관3h、술후1d、술후3d、술후7d）적인지공능정황、소성정황、발관정황、수술전후상관지표（동형반광안산、결양유도인자‐1α）적개변정황。결과관찰조환자재발관1 h、발관3 h시MMSE평분균명현저우대조조。관찰조환자소성시간、발관시간、정향력회복시간균명현만우대조조。관찰조환자재절피전、담낭절제시、발관30 m in시상관지표（동형반광안산、결양유도인자‐1α）균명현저우대조조，차이균유통계학의의（ P ＜0.05）。결론술중BIS유지재40～49시，대노년환자복강경담낭술후조기적인지공능장애영향교대，수후축점회복지정상수평，능구조성소성연지，대동형반광안산、결양유도인자‐1α구유교호적억제효과，치득림상추엄사용。
Objective To investigate the influence of different anesthesia depth on postoperative cognitive dysfunction in elderly patients with laparoscopic cholecystectomy .Methods Ninety‐four elderly patients with lap‐aroscopic cholecystectomy were selected in hospital from October 2011 to December 2013 ,who were treated anes‐thesia depth monitoring by Bispectral index (BIS) .Patients were randomly divided into two groups .Forty‐seven patients were maintained 50‐59 in BIS as control group .Forty‐seven patients were maintained 40‐49 in BIS as ob‐servation group .Cognitive function was evaluated by mini mental state examination (MMSE) .Cognitive function at different time points (preoperative ,extubation 1 h ,extubation 3 h ,postoperative 1 d ,postoperative 3 d ,post‐operative 7 d) ,wake conditions ,extubation and changes of related indexes (Hcy ,HIF‐1α) were compared be‐tween two groups .Results MMSE score at extubation 1 h ,extubation 3 h in observation group were significantly lower than those in control group .Recovery time ,extubation time and orientation recovery time in observation group were significantly later than those in control group .Related indexes (Hcy ;HIF‐1α) before skin incision , cholecystectomy ,extubation 30 min in observation group were significantly lower than those in control group . Differences were statistically significant (P< 0 .05) .Conclusion It has larger influence on postoperative early cognitive dysfunction in elderly patients with laparoscopic cholecystectomy ,which intraoperative BIS maintained 40‐49 .And then it gradually returned to normal level ,which has better inhibitory effect on Hcy and HIF‐1α.That is worthy of clinical use .