摘要
目的:观察老年微创胆囊切除术中麻醉深度对患者应激反应及认知水平的影响,旨在为此类患者术中麻醉深度选择提供依据。方法:选取我院收治的胆囊结石且需行腹腔镜胆囊切除术(LC)治疗的老年患者90例,依据随机数字表法分为观察Ⅰ、Ⅱ、Ⅲ组,三组患者术中使用麻醉深度监测系统(narcotrend,NT)监测,并分别将麻醉深度维持在D0、D1及D2水平,监测并记录3组患者麻醉诱导前、气管插管前、后、手术开始、结束、拔管时的生命体征;测定麻醉诱导前、手术开始及结束、术后第1、4天时的促肾上腺皮质激素(adrenocorticotrophic hormone,ACTH)、皮质醇(cortisol,COR)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平;并使用蒙特利尔认知功能量表(montreal cognitive assessment scale,MOCA)及简易精神状态量表(mini-mental state examination,MMSE)对患者术前第1天及术后第4的认知情况进行评价。结果:3组患者气管插管后、手术开始、结束及拔管时MAP、HR维持以观察Ⅲ组波动最小;观察Ⅰ组手术开始时COR水平明显高于观察Ⅲ组(P<0.05),手术结束时COR水平明显高于观察Ⅱ组和观察Ⅲ组(P<0.05),观察Ⅱ组患者手术开始及结束时COR水平明显高于观察Ⅲ组(P<0.05);观察I、Ⅱ组手术开始及结束时ACTH水平明显高于观察Ⅲ组(P<0.05);3组患者各时间点TNF-α水平比较无明显差异(P>0.05);3组患者术前1d及术后第4d的MOCA、MMSE评分比较无统计学差异(P>0.05)。结论:将LC围术期老年患者麻醉深度维持在D2水平,更有利于维持围手术期机体血流动力学稳定,降低围手术期机体应激反应。
Objective：To observe the effect of anesthesia depth on the stress reaction and cognitive level in elderly patients who underwent minimally invasive cholecystectomy and to provide a basis for the selection of anesthesia depth.Methods：A total of 90 elderly patients with gallstone who were admitted in our hospital for laparoscopic cholecystectomy（LC）were included in the study and randomized into the observationⅠ,Ⅱ,and Ⅲ groups.Narcotrend（NT）was used to monitor the anesthesia depth during operation in the three groups,and the anesthesia depth was maintained at D0,D1,and D2 levels,respectively.The vital signs before anesthesia induction,before and after tracheal intubation,before and after operation,and extubation in the three groups were monitored and recorded.ACTH,COR,and TNF-αlevels before anesthesia induction,before and after operation,1 and 4 dafter operation were detected.MOCA and MMSE were used to evaluate the cognition 1 dbefore operation and 4 dafter operation.Results：The fluctuation of MAP and HR after tracheal intubation,before and after operation,and extubation in observation Ⅲ group was the smallest.COR level before operation in observation I group was significantly higher than that in observation Ⅲ group（P〈0.05）,while COR level after operation was significantly higher than that in the observationⅡ andⅢ groups（P〈0.05）,and COR level before and after operation in observation Ⅱ group was significantly higher than that in observationⅢ group（P〈0.05）.ACTH level before and after operation in observation Ⅰ and Ⅱ groups was significantly higher than that in observation Ⅲ group（P〈0.05）.The comparison of TNF-αlevel at each timing-point among the three groups was not statistically significant（P〉0.05）.The comparison of MOCA and MMSE scores 1 dbefore operation and 4 dafter operation among the three groups was not statistically significant（P〉0.05）.Conclusions：The anesthesia depth maintaining at D2 level for elderly patients during perioperative period of LC is more beneficial to maintaining the stability of haemodynamics,and reducing the stress reaction.
作者
孙明哲
SUN Ming-zhe(Department of Anesthesiology,the 251th Hospital of the Chinese People＇s Liberation Army,Hebei,Zhangjiakou 075000,China)
出处
《海南医学院学报》
CAS
2018年第17期1574-1577,共4页
Journal of Hainan Medical University
基金
河北省科技进步项目(2014JB2049)~~
关键词
麻醉深度
老年
LC
应激反应
认识水平
Anesthesia depth
Elderly
LC
Stress reaction
Cognitive level
