脑电麻醉深度监护仪在老年患者腹腔镜胆囊切除术麻醉中的应用及对术后谵妄的影响

The application of electroencephalogram-based depth of anesthesia monitoring in elderly patients undergoing laparoscopic cholecystectomy and its effects on postoperative delirium

摘要:

目的 探讨脑电麻醉深度监护仪在老年腹腔镜胆囊切除术患者麻醉中的应用及对术后谵妄 （POD）的影响。方法 选择2017年1月—2019年12月绍兴市上虞中医医院收治的腹腔镜胆囊切除术老年患 者160例。根据随机数字法分为对照组和观察组，每组80例。对照组根据患者生命体征和麻醉师临床经验进 行麻醉诱导和维持，观察组采用Angel-6000型脑电麻醉深度监护仪调整麻醉诱导和维持剂量。记录两组患 者手术时间、拔管时间、清醒时间、麻醉药品用量。记录麻醉前 （T0 ）、插管后 （T1 ）、手术10 min （T2 ）、 术毕 （T3 ）、拔管前 （T4 ）、拔管后 （T5 ） 时相应意识指数 （IoC）。采用谵妄评定量表 （CAM） 评估谵妄情 况，酶联免疫吸附试验测定血清白细胞介素-6（IL-6）和S-100β水平。结果 观察组拔管时间和清醒时间 短于对照组（P <0.05）。两组各时间点平均动脉压（MAP）、心率（HR）、IoC值比较，采用重复测量设计的 方差分析，结果：①不同时间点MAP、HR、IoC值有差别（P <0.05）；②观察组与对照组MAP、HR、IoC 值有差别（P <0.05）；③两组MAP和HR变化趋势无差别（P >0.05），IoC值变化趋势有差别（P <0.05）。观 察组丙泊酚用量少于对照组（P <0.05）。观察组术后24 h POD发生率低于对照组（P <0.05）。观察组手术前后 CAM评分和血清IL-6、S100β水平的差值低于对照组（P <0.05）。结论 老年腹腔镜胆囊切除术患者采用脑 电麻醉深度监护仪检测麻醉深度可调控麻醉药用量，减少神经损伤，减少术后POD的发生。

Abstract:

Objective To investigate the application of electroencephalogram-based depth of anesthesia monitoring in elderly patients undergoing laparoscopic cholecystectomy and its effect on postoperative delirium (POD). Methods A total of 160 elderly patients undergoing laparoscopic cholecystectomy in our hospital from January 2017 to December 2019 were selected and divided into control group and observation group according to the random number method, with 80 patients in each group. The control group was performed anesthesia induction and maintenance based on the patients’vital signs and clinical experience of the anesthesiologist. The observation group used Angel-6000 electroencephalogram-based depth of anesthesia monitor to adjust the anesthetics dosage for anesthesia induction and maintenance. The operation time, extubation time, awakening time and dosage of anesthetic drugs in the two groups were recorded. The index of consciousness (IoC) values before anesthesia (T0), after intubation (T1), 10 min after initiation of surgery (T2), after surgery (T3), before extubation (T4) and after extubation (T5) were recorded. The Confusion Assessment Method (CAM) was used to assess delirium. Enzyme-linked immunosorbent assay was used to determine serum interleukin-6 (IL-6) and S-100β levels. Results The extubation time and awakening time were shorter in the observation group than those in the control group (P < 0.05). The mean arterial pressure (MAP), heart rate (HR) and IoC values were different between the two groups and at different time points (P < 0.05). There was no difference in the changing trend of MAP and HR between the observation and the control group (P > 0.05), but the changing trend of IoC value was different between the observation group and the control group (P < 0.05). The dosage of propofol in the observation group was less than that in the control group (P < 0.05). The incidence of POD at 24 hours after operation in the observation group was lower than that in the control group (P < 0.05). The differences of CAM score and serum IL-6 and S100β levels before and after operation in observation group were lower than those in control group (P < 0.05). Conclusions The electroencephalogrambased depth of anesthesia monitoring can effectively detect the depth of anesthesia and therefore regulate the dosage of anesthetics in elderly patients undergoing laparoscopic cholecystectomy, which reduces nerve damage and the incidence of POD.