CAJ | 학술논문

目的：探讨两种麻醉深度对老年患者脑氧代谢和术后认知功能的影响。方法2011年2月到2015年1月选择老年腹腔镜下胆囊切除术患者80例作为研究对象，根据麻醉深度不同分为观察组与对照组各40例。两组都采用静脉麻醉，对照组术中脑电双频指数（BIS）值维持在50~59间，观察组术中 BIS 值维持在30~39间。观察比较两组认知功能评分、脑氧代谢检测、不良反应情况以及麻醉效果。结果两组术后1 d 的简易精神状态量表（MMSE）评分都明显低于术前（ P ﹤0.05），观察组术后7 d 的 MMSE 评分明显高于对照组（ P ﹤0.05），同时与术前评分对比差异无统计学意义。两组麻醉诱导后30 min 与术后时间点的动脉血氧含量（CaO2）和混合静脉血氧含量（CvO2）值明显低于术前（ P ﹤0.05），但不同时间点的 CaO2和 CvO2值的组间对比差异均无统计学意义（ P ﹥0.05）。观察组的苏醒时间、拔管时间和定向力恢复时间都明显低于对照组，差异有统计学意义（ P ﹤0.05）。治疗组术后7 d 内恶心呕吐、低氧血症、肺部感染、切口感染等并发症发生率明显低于对照组（ P ﹤0.05）。结论在老年腹腔镜下胆囊切除术患者中，相对于 BIS值维持在50~59间，术中 BIS 值维持在30~39间对于脑氧代谢无明显负面影响，麻醉效果更好，能促进恢复术后认知功能，安全性好，值得推广应用。
목적：탐토량충마취심도대노년환자뇌양대사화술후인지공능적영향。방법2011년2월도2015년1월선택노년복강경하담낭절제술환자80례작위연구대상，근거마취심도불동분위관찰조여대조조각40례。량조도채용정맥마취，대조조술중뇌전쌍빈지수（BIS）치유지재50~59간，관찰조술중 BIS 치유지재30~39간。관찰비교량조인지공능평분、뇌양대사검측、불량반응정황이급마취효과。결과량조술후1 d 적간역정신상태량표（MMSE）평분도명현저우술전（ P ﹤0.05），관찰조술후7 d 적 MMSE 평분명현고우대조조（ P ﹤0.05），동시여술전평분대비차이무통계학의의。량조마취유도후30 min 여술후시간점적동맥혈양함량（CaO2）화혼합정맥혈양함량（CvO2）치명현저우술전（ P ﹤0.05），단불동시간점적 CaO2화 CvO2치적조간대비차이균무통계학의의（ P ﹥0.05）。관찰조적소성시간、발관시간화정향력회복시간도명현저우대조조，차이유통계학의의（ P ﹤0.05）。치료조술후7 d 내악심구토、저양혈증、폐부감염、절구감염등병발증발생솔명현저우대조조（ P ﹤0.05）。결론재노년복강경하담낭절제술환자중，상대우 BIS치유지재50~59간，술중 BIS 치유지재30~39간대우뇌양대사무명현부면영향，마취효과경호，능촉진회복술후인지공능，안전성호，치득추엄응용。
Objective To investigate the cerebral oxygen metabolism and postoperative cognitive function effects of different depth of anes-thesia in elderly patients. Methods From February 2011 to January 2015,we selected 80 elderly patients with laparoscopic cholecystectomy for the study. All patients were equally divided the observation group and the control group by the different depth of anesthesia. Patients of both groups used intravenous anesthesia,the patients of control group intraoperative bispectral index(BIS)values remained at 50 ~ 59 rooms,and the observa-tion group BIS value was maintained at between 30 ~ 39. Results The postoperative 1 d MMSE scores were significantly lower than the preopera-tive in the two groups( P ﹤ 0. 05),but the postoperative 7 d MMSE scores in the observation group were significantly higher( P ﹤ 0. 05). While compared with the preoperative score,the difference were not statistically significant. The T2 and T3 time points arterial oxygen content(CaO2 ) and mixed venous oxygen content(CvO2 )were significantly lower than the T1 time point( P ﹤ 0. 05),but compared at different points in times of CaO2 and CvO2 values the differences between the groups were not statistically significant( P ﹥ 0. 05). The recovery time,extubation time and orientation recovery time in the observation group were significantly lower. The differences were statistically significant( P ﹤ 0. 05). The postoper-ative 7 d nausea and vomiting,hypoxemia,pulmonary infection,wound infection and other complications in the treatment group were significantly less than the control group( P ﹤ 0. 05). Conclusion In elderly patients with laparoscopic cholecystectomy,the BIS value is maintained at be-tween 50 ~ 59,the intraoperative BIS value is maintained at between 30 - 39 cerebral oxygen metabolism for no apparent negative impact. This method has better anesthetic effect,can promote recovery of postoperative cognitive function,its safety and should be widely applied.