【摘要】 目的观察和分析不同麻醉深度对老年患者术后认知功能和血清S100-β蛋白水平的影响。方法选取全身麻醉下行腹部手术的老年患者100例作为研究对象,将其随机分为浅麻醉组和深麻醉组,每组各50例。将浅麻醉组患者术中的Narcotrend麻醉深度指数(NTI)的变动范围控制在47-64,将深麻醉组患者术中NTI的变动范围控制在20-36。对两组患者术中各观察时点的NTI、平均动脉压(MAP)、心率(HR)进行记录和比较;应用简易精神状态检查表(MMSE)对两组患者发生术后认知功能障碍(POCD)的情况进行观察和比较;对于术中和术后各观察时点两组患者血清S-100β蛋白浓度进行检测和比较;应用视觉疼痛评分(VAS)对两组患者的术后疼痛程度进行评价;对两组患者术中丙泊酚和瑞芬太尼的用量及血管活性药物的使用比例进行观察和比较。结果两组患者在麻醉时间、手术时间、瑞芬太尼用量和术后VSA评分等方面的差异无显著性(P>0.05),两组患者的MAP和HR的组间差异无显著性(P>0.05),两组应用血管活性药物的患者比例的差异无显著性(P>0.05),浅麻醉组患者的丙泊酚用量显著低于深麻醉组(P<0.05);浅麻醉组和深麻醉组的POCD发生率分别为42%和14%,浅麻醉组患者的POCD发生率显著高于深麻醉组(P<0.05);两组患者的血清S-100β蛋白水平在术中均显著上升(P<0.05),且浅麻醉组患者的术中S-100β蛋白水平均高于深麻醉组患者同时点水平(P<0.05)。结论不同麻醉深度均可保证老年患者术中和术后血流动力学的平衡,其麻醉效果和术后疼痛程度基本相当,不同麻醉深度患者在术中均有中枢神经系统的损伤,但麻醉深度较浅患者的术中血清S-100β蛋白水平较高,神经系统损伤程度更严重,术中维持较深的麻醉管理可降低老年患者POCD的发生率。更多还原

【Abstract】 Objective To observe and analyze the effect of different anesthesia depth on the cognitive function and the serum S100-βprotein level of the elderly patients after operation.Methods 100cases of the elderly patients treated with abdominal operation in general anesthesia were selected as the research objects and randomly divided into the shallow anesthesia group and the deep anesthesia group.50patients were included into each group.The Narcotrend anesthesia depth indexes(NTI)of the patients in the shallow anesthesia group were controlled in the range of 47-64,while the NTIs of the patients in the deep anesthesia group were controlled in the range of 20-36.The NTI,mean arterial pressure(MAP),and heart rate(HR)of the patients in the two groups at each observation time point during the operation were recorded and compared;the Minimental State Examination(MMSE)scale was employed to observe and compare the incidences of postoperative cognitive dysfunction(POCD)of the patients in the two groups;the serum S-100βprotein concentrations of the patients in the two groups at intraoperative and postoperative observation points were detected and compared;the Visual Analogue Scale(VAS)was applied to evaluate the degree of pain of the patients in the two groups after the operation;the dosage of propofol and remifentanil applied in the operation and the proportion of the patients treated with vasoactive drugs in the two group were observed and compared.Results The differences of anesthesia time,operation time,dose of remifentanil and postoperative VSA scores between the patients in the two groups were not significant(P>0.05).The differences of MAP and HR between the two groups were not significant(P>0.05).There was no significant difference of the application of vasoactive drugs ratio between the two groups(P>0.05).The propofol dosage of the patients in the shallow anesthesia group was significantly lower than that of the deep anesthesia group(P<0.05);the POCD incidences of the shallow anesthesia group and the deep anesthesia group were 42% and 14%respectively and the POCD incidence of the patients in the shallow anesthesia group was higher than that of the deep anesthesia group(P<0.05);the serum S-100β protein levels of the patients in the two groups increased significantly at the time points during the operation(P<0.05)and the S-100βprotein levels of the patients in the shallow anesthesia group were significantly higher than that of the deep anesthesia group at the same time point(P<0.05).Conclusion The different depth of anesthesia can guarantee the intraoperative and postoperative balances of hemodynamics of the elderly patients.Their anesthetic effects and the postoperative degree of pains are basically equal.There is the central nervous system injury during surgery with the patients in different depth of anesthesia,but the serum S-100β protein level of the patients in rather shallow anesthesia depth is in a higher degree and the damage to the nervous system is more serious.To maintain a deeper anesthesia management during the operation can reduce the incidence of POCD of the elderly patients.更多还原