摘要
目的探讨多参数脑电监测对老年患者下腹部腹腔镜手术中脑电爆发抑制(BS)和术后谵妄(POD)的影响。方法选择行下腹部手术老年患者100例,男48例,女52例,年龄65~85岁,BMI 18.5~28.0 kg/m^(2),ASAⅡ或Ⅲ级,采用随机数字表法将患者分为两组:多参数组和单参数组,每组50例。多参数组采用患者状态指数(PSI)、谱缘频率(SEF)、爆发抑制率(BSR)以及密度谱阵列(DSA)的多参数脑电监测指导麻醉深度管理;单参数组采用PSI单参数指导麻醉深度管理。计算基于MAP的低血压阈值下总面积(AUT MAP)。记录术中麻醉药用量和血管活性药使用情况、麻醉时间、拔管时间、PACU停留时间、术后住院时间。记录麻醉诱导前、麻醉诱导后5 min、切皮后5、30、60 min和手术结束时的HR、MAP、PSI和SEF。记录术中BS发生率、BS持续时间以及BSR最大值。记录术后1、2、3 d的POD发生情况。结果两组AUT MAP值差异无统计学意义。与单参数组比较,多参数组丙泊酚和瑞芬太尼用量明显减少(P<0.05),拔管时间、PACU停留时间、术后住院时间明显缩短(P<0.05),切皮后5、30、60 min和手术结束时PSI明显升高(P<0.05),麻醉诱导后5 min、切皮后5、30、60 min和手术结束时SEF明显升高(P<0.05)。与单参数组比较,多参数组BS发生率明显降低,BS持续时间明显缩短,BSR最大值明显减小,术后1 d的POD发生率明显降低(P<0.05)。结论多参数脑电监测指导下麻醉管理可以抑制老年患者下腹部手术中脑电BS的发生,减轻脑电BS的程度,降低POD的发生率。
Objective To explore the effect of multiparameter electroencephalogram(EEG)-guided anesthesia management on EEG burst suppression(BS)and postoperative delirium(POD)in elderly patients undergoing lower abdominal laparoscopic surgery.Methods A total of 100 elderly patients,48 males and 52 females,aged 65-85 years,BMI 18.5-28.0 kg/m^(2),and ASA physical statusⅡorⅢ,were enrolled for lower abdominal surgery under general anesthesia.Patients were randomly divided into two groups:multiparameter group and single parameter group,50 patients in each group.In multiparameter group,multiparameter EEG monitoring with patient statu index(PSI),spectral edge frequency(SEF),burst suppression ratio(BSR)and density spectral array(DSA)were used to guide the depth management of anesthesia.In single parameter group,single parameter PSI was used to guide the depth management of anesthesia.The total area under the hypotensive threshold of MAP(AUT MAP)was calculated,and the amount of anesthetic used during the operation and the use of vasoactive drugs,duration of anesthesia,extubation time,duration of PACU stay,and postoperative hospitalisation days were recorded.HR,MAP,PSI,and SEF were recorded before the induction of anesthesia,5 minutes after induction of anesthesia,5,30,and 60 minutes after incision,and at the end of surgery.The incidence,duration,and maximum BSR of intraoperative BS,as well as the incidence of POD_(1),2,and 3 days after surgery were recorded.Results There was no significant difference in AUT MAP values between the two groups.Compared with single parameter group,intraoperative propofol and remifentanil dosage were significantly decreased(P<0.05),awakening time,PACU stay,and postoperative hospitalization time were significantly shorter in multiparameter group(P<0.05),the PSI was significantly increased 5,30,and 60 minutes after incision and at the end of surgery,and the SEF was significantly increased 5 minutes after induction of anesthesia,5,30,and 60 minutes after induction and the end of surgery(P<0.05).Compared with single parameter group,incidence of intraoperative BS was significantly decreased,duration of BS was significantly shorter,smaller maximum BSR was significantly decreased,and incidence of POD on 1 day after surgery in multiparameter group(P<0.05).Conclusion Anesthesia management guided by multiparameter EEG can inhibit the occurrence of BS,mitigate the degree of BS,and reduce the incidence of POD in elderly patients undergoing abdominal surgery.
作者
陈健
冯悦
沈珀
刘晶晶
钟艺
张鑫龙
张加永
胡玉萍
斯妍娜
CHEN Jian;FENG Yue;SHEN Po;LIU Jingjing;ZHONG Yi;ZHANG Xinlong;ZHANG Jiayong;HU Yuping;SI Yanna(Department of Anesthesiology,the Fourth Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2024年第9期905-910,共6页
Journal of Clinical Anesthesiology
基金
国家自然科学基金(81873954)
江苏省六大人才高峰项目(WSW-106)
南京市卫生科技发展专项资金资助项目(ZKX22030)。
关键词
脑电监测
全身麻醉
老年
下腹部手术
爆发抑制
术后谵妄
Electroencephalogram monitoring
General anesthesia
Aged
Lower abdominal surgery
Burst suppression
Postoperative delirium
