标题：基于脑电双频谱指数的不同麻醉深度对老年腹腔镜手术患者炎症反应和术后认知功能的影响

      作者：安慎通，王煜，范倩倩    空军军医大学第一附属医院麻醉与围术期医学科，陕西 西安 710000

      卷次： 2019年30卷19期

      【摘要】 目的 探究基于脑电双频谱指数(BIS)的不同麻醉深度对老年腹腔镜手术患者炎症反应和术后认知功能的影响。方法 回顾性分析2017年1月至2019年1月在空军军医大学第一附属医院行腹腔镜手术治疗的94例老年胆囊疾病患者的临床资料，按照不同麻醉深度分为对照组和观察组，每组47例，对照组患者BIS维持在50~59，观察组患者BIS维持在 40~49。观察指标：两组患者麻醉前(T0)、切皮时(T1)、手术 30 min时(T2)、手术结束时(T3)以及气管插管拔管时(T4)的平均动脉压(MAP)和心率(HR)变化；术后苏醒时间、拔管时间以及定向力恢复时间；白细胞介素-6 (IL-6)、S-100β蛋白水平；术前及术后1 d、3 d、7 d简易智力状态检查表(MMSE)评分，以及认知功能障碍(POCD)发生情况。结果 两组患者各时间点的MAP、HR比较差异均无统计学意义(P>0.05)；观察组患者的苏醒时间、拔管时间及定向力恢复时间分别为(16.60±1.72) min、(19.84±2.64) min、(27.15±2.78) min，明显高于对照组的(15.14±1.33) min、(16.74±2.23) min、(22.29±2.40) min，差异均有统计学意义(P<0.05)；观察组术毕、术后第1天、术后第3天的 IL-6、S-100β水平明显低于对照组，差异均有统计学意义(P<0.05)；两组患者各时间点 IL-6、S-100β水平为术毕明显高于术前，术前明显高于术后第 1天，术后第 1天明显高于术后第 3天，差异均有统计学意义(P<0.05)；观察组患者术前、术后第1天、术后第3天、术后第7天的 MMSE评分分别为(27.52±2.21)分、(24.65±2.31)分、(25.37±2.19)分、(27.17±2.19)分，对照组患者术前、术后第1天、第3天、第7天的MMSE评分分别为(27.36±2.16)分、(23.08±2.46)分、(24.76±2.24)分、(26.51±2.26)分，组间比较，观察组患者术后第1天的MMSE评分明显高于对照组，差异有统计学意义(P<0.05)；观察组术后第1天和术后第3天MMSE评分均明显低于术前和术后第7天，对照组各时间点MMSE评分为第1天明显高于术后第3天，术后第3天明显高于术前和术后第7天，差异均有统计学意义(P<0.05)；观察组患者第1天、第3天的 POCD发生率分别27.66%、14.89%，明显低于对照组的51.06%、38.30%，差异均有统计学意义(P<0.05)，而第 7天，两组患者的POCD发生率比较差异无统计学意义(P>0.05)。结论 BIS维持在40~49的深度麻醉可延迟术后苏醒时间、降低炎症因子水平和术后早期认知障碍的发生率，减轻脑功能损伤。
      【关键词】 脑电双频谱指数；麻醉深度；老年；腹腔镜手术；炎症反应；认知功能
      【中图分类号】 R656 【文献标识码】 A 【文章编号】 1003—6350（2019）19—2490—04

Effect of different anesthesia depth based on bispectral index of EEG on inflammatory response andpostoperative cognitive function in elderly patients undergoing laparoscopic surgery.
AN Shen-tong, WANG Yu,FAN Qian-qian. Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Air Force MilitaryMedical University, Xi'an 710000, Shaanxi, CHINA
【Abstract】 Objective To explore the effects of different anesthesia depths based on bispectral index (BIS)on inflammatory response and postoperative cognitive function in elderly patients undergoing laparoscopic surgery.Methods The clinical data of 94 elderly patients with gallbladder diseases who underwent laparoscopic surgery in theFirst Affiliated Hospital of Air Force Medical University from January 2017 to January 2019 were retrospectively ana-lyzed. According to different anesthetic depth, the patients were divided into control group and observation group, with47 cases in each group. The BIS of control group was maintained at 50-59, while that of observation group was main-tained at 40~49. Changes of the following indexes were observed: mean arterial pressure (MAP) and heart rate (HR) be-fore anesthesia (T0), at skin incision (T1), 30 minutes after operation (T2), at the end of operation (T3) and during trache-al intubation and extubation (T4); recovery time after operation, extubation time, and directional recovery time; levels ofinterleukin-6 (IL-6), S-100β protein; the scores of MMSE and the occurrence of cognitive impairment (POCD) beforeoperation, and 1 d, 3 d and 7 d after operation. Results There were no significant differences in MAP and HR betweenthe two groups at each time point (P>0.05). The recovery time, extubation time, and orientation recovery time of the ob-servation group were (16.60±1.72) min, (19.84±2.64) min, (27.15±2.78) min, significantly higher than (15.14±1.33) min,(16.74±2.23) min, (22.29±2.40) min in the control group (P<0.05). The levels of IL-6 and S-100β in the observationgroup were significantly lower than those in the control group at the end of operation, on the first day after operation and