不同麻醉深度对老年患者术后认知功能的影响.docVIP

不同麻醉深度对老年患者术后认知功能的影响 　　[摘 要] 目的：探讨全身麻醉不同麻醉深度对老年患者术后认知功能的影响。方法：选择2014年1月至2015年12月在我院拟行全麻手术的患者155例，60～91岁，ASAⅠ～Ⅳ 级，随机分为浅麻醉组（A组，n=78）和深麻醉组（B组，n=77）。浅麻醉患者维持麻醉深度指数在47～64，深麻醉患者维持麻醉深度在35～45之间。比较2组患者术后认知功能以及血清中炎症因子和S100蛋白表达水平的差异。结果：B组患者术后1d、7d的认知功能评分明显高于A组，差异有统计学意义，且B组患者术后1d、7d的血清中TNF-α、IL-10和S100β明显低于A组，差异有统计学意义。结论：全身麻醉过程中维持BIS值在35～45的深麻醉状态能够降低患者全身炎症反应及S100β的水平，减少老年患者术后认知功能的损伤。 　　[关键词] 麻醉深度；老年；术后认知功能障碍；全身麻醉 　　中图分类号：R614 文献标识码：B 文章编号：2095-5200（2016）03-052-03 　　[Abstract] Objective： To investigate the effects of different depth of anesthesia general anesthesia on postoperative cognitive function in the elderly. Methods： 155 cases of patients who underwent surgery under general anesthesia from January 2014 to December 2015 in our hospital， 60-91 years old， grade ASAⅠ-Ⅳ， were randomly divided into light anesthesia group （group A， n=78） and deep anesthesia group （group B， n=77）. The depth index of anesthesia was maintained to be 47-64 in light anesthesia group， 35-45 in deep anesthesia group. The differences in postoperative cognitive function as well as in serum inflammatory cytokines and S100 protein levels between two groups were compared. Results： Cognitive function score of group B at 1 d， 7 d after surgery were significantly higher than those of group A， the difference was statistically significant， and serum TNF-α， IL-10 and S100β of group B at 1 d， 7 d after surgery were significantly lower than those of group A， the difference was statistically significant. Conclusions： To maintain BIS values on 35-45 of deep anesthesia during general anesthesia can reduce the patients’ systemic inflammatory response and S100β levels， decrease the damage of postoperative cognitive function in elderly patients. 　　[Key words] the depth of anesthesia； elderly； postoperative cognitive dysfunction； general anesthesia 　　术后认知功能障碍是老年患者术后早期较常见并发症之一，老年非心脏手术患者术后1周内认知功能障碍发生率可高达47%，因其发生率高且增加了老年患者术后病死率而备受关注。术后认知功能障碍机制复杂，麻醉是导致其发生因素之一。本研究将分析全身麻醉不同麻醉深度对老年患者术后认知功能影响，为老年患者麻醉提供参考。 　　1 资料与方法