| 陈梦洁,刘晶宇,熊金敏,萨达凯提·艾买提,张 冰.全身麻醉下不同脑电双频指数对老年胃肠道恶性肿瘤患者应激反应、炎性因子和术后认知功能的影响[J].,2022,(13):2524-2529 |
| 全身麻醉下不同脑电双频指数对老年胃肠道恶性肿瘤患者应激反应、炎性因子和术后认知功能的影响 |
| Effects of Different Bispectral Index on Stress Response, Inflammatory Factors and Postoperative Cognitive Function in Elderly Patients with Gastrointestinal Malignant Tumors Under General Anesthesia |
| 投稿时间：2022-01-23 修订日期：2022-02-18 |
| DOI：10.13241/j.cnki.pmb.2022.13.024 |
| 中文关键词: 全身麻醉 脑电双频指数 老年 胃肠道恶性肿瘤 应激反应 炎性因子 认知功能 |
| 英文关键词: General anesthesia Bispectral index Elderly Gastrointestinal malignant tumors Stress response Inflammatory factors Cognitive function |
| 基金项目:新疆医科大学附属肿瘤医院临床研究项目（2019CL02010）；新疆维吾尔自治区自然科学基金项目（2020D01C209） |
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| 中文摘要: |
| 摘要 目的：观察全身麻醉下不同脑电双频指数（BIS）对老年胃肠道恶性肿瘤患者应激反应、炎性因子和术后认知功能的影响。方法：选择2020年10月-2021年4月在新疆医科大学附属肿瘤医院初诊的住院老年胃肠道恶性肿瘤患者，共98例。据随机数字表法分为浅麻醉组（n=49，BIS值45~55）和深麻醉组（n=49，BIS值30~40）。对比两组苏醒质量、应激反应、炎性因子、术后认知功能、血流动力学及不良反应。结果：浅麻醉组的苏醒时间、定向力恢复时间、气管拔管时间短于深麻醉组（P<0.05）。插管后即刻（T1）~术毕（T5）时间点，两组心率（HR）、平均动脉压（MAP）均下降后升高（P<0.05）。深麻醉组T1~T5时间点HR、MAP高于浅麻醉组（P<0.05）。手术开始2 h（T4）、拔管后60 min（T6）时间点，两组皮质醇（Cor）、促肾上腺皮质激素（ACTH）水平呈升高趋势，且浅麻醉组高于深麻醉组（P<0.05）。T4、T6时间点，两组白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平持续升高，但浅麻醉组低于深麻醉组（P<0.05）。深麻醉组的术后3 d、术后7 d 简明精神状态量表（MMSE）评分低于浅麻醉组（P<0.05）。两组不良反应发生率组间对比无差异（P>0.05）。结论：全身麻醉下老年胃肠道恶性肿瘤患者BIS值范围30~40可维持更平稳的血流动力学，应激反应低，但是其对认知功能影响相对较大；BIS值在45~55之间时，患者苏醒快，炎性因子水平更低；临床应结合实际情况合理调控BIS值。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the effects of different bispectral index (BIS) on stress response, inflammatory factors and postoperative cognitive function in elderly patients with gastrointestinal malignant tumors under general anesthesia. Methods: A total of 98 hospitalized elderly patients with gastrointestinal malignant tumors who were newly diagnosed in the Affiliated Cancer Hospital of Xinjiang Medical University from October 2020 to April 2021 were selected.According to the random number table method, they were divided into shallow anesthesia group (n=49, BIS value 45~55) and deep anesthesia group (n=49, BIS value 30~40). The awakening quality, stress response, inflammatory factors, postoperative cognitive function, hemodynamics and adverse reactions were compared between the two groups. Results: The awakening time, directional force recovery time and tracheal extubation time of shallow anesthesia group were shorter than those of deep anesthesia group (P<0.05). Heart rate (HR) and mean arterial pressure (MAP) decreased and then increased in the two groups at immediately after intubation (T1) ~ completion of operation (T5) time points(P<0.05). HR and MAP at T1~T5 time points of deep anesthesia group were higher than those of shallow anesthesia group (P<0.05). The levels of cortisol (Cor) and adrenocorticotropic hormone (ACTH) in the two groups increased at 2 h after operation (T4) and 60 min after extubation (T6) time points, and the shallow anesthesia group was higher than the deep anesthesia group(P<0.05). At T4 and T6 time points, the levels of interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) increased continuously, but the shallow anesthesia group was lower than the deep anesthesia group(P<0.05). The Mini-Mental State Examination(MMSE) score of deep anesthesia group was lower than that of shallow anesthesia group at 3 d and 7 d after operation(P<0.05). There was no difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: Under general anesthesia, the BIS value range of 30~40 in elderly patients with gastrointestinal malignant tumors can maintain more stable hemodynamics and low stress response, but it has a relatively large impact on cognitive function. When the BIS value is between 45 and 55, the patient wakes up quickly and the level of inflammatory factors is lower. The BIS value should be adjusted and controlled reasonably in combination with the actual situation. |
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