吸入麻醉对认知功能减退老年患者脑电双频谱指数的影响

摘要/Abstract

摘要： 目的：探讨吸入麻醉对认知选择功能减退老年患者意识消失、意识恢复以及麻醉加深过程中脑电双频谱指数（bispectral index，BIS）的影响。方法：选择北京大学第三医院2012年1~9月行择期手术的65岁以上老年患者，使用简易智能量表筛选出认知功能减退者60例和认知功能正常者60例。应用七氟醚实施全身麻醉，记录两组患者意识消失和意识恢复时的BIS，以及呼气末七氟醚体积分数（end-tidal concentration of sevoflurane，C_ETSev）变化于0.7%~2.8%过程中的BIS，采用独立样本t检验和重复测量数据的方差分析进行两组比较。结果：共117例患者完成了研究，认知功能减退组患者意识消失时的BIS高于认知功能正常组，差异有统计学意义（P<0.01），恢复时BIS的差异无统计学意义（P>0.05），认知功能减退组患者的BIS在C_ETSev变化于0.7%~2.8%过程中低于认知功能正常组，差异有统计学意义（P<0.05），C_ETSev分别为0.7%、1.05%、1.4%和1.75%时，认知功能减退组患者的BIS低于认知功能正常组，差异有统计学意义（P<0.05），C_ETSev分别为2.1%、2.45%和2.8%时BIS的差异无统计学意义（P>0.05）。结论：吸入麻醉期间，认知功能减退老年患者意识消失时的BIS水平高于正常患者，麻醉加深过程中的BIS水平低于正常患者，在浅麻醉时更为明显，其机制可能与认知功能减退相关的神经系统退行性变以及神经递质系统功能障碍有关。

关键词: 麻醉, 吸入, 认知障碍, 老年人

Abstract: To investigate the influence of inhaled anesthesia on bispectral index (BIS) of elderly patients with cognitive decline at loss of consciousness and regain of consciousness, and on deepening of sedation. Methods: The patients aged more than 65 years undergoing elective operations from January 2012 to September 2012 were recruited, then 60 cognitive intact patients and 60 cognitive decline patients were screened by mini-mental state examinations. Inhaled anesthesia was administered using sevoflurane. BIS’s of the two groups at loss of consciousness and regain of consciousness, and during endtidal concentration of sevoflurane (C_ETSev) changing from 0.7% to 2.8% were recorded. The data were compared with independent-samples t test and repeated-measures general linear model of ANOVA. Results: In the study, 117 patients finshed the investigation, The BIS’s of the cognitive decline group at loss of consciousness were significantly higher than those of the cognitive intact group (P<0.01). There were no significant differences at regain of consciousness between the two groups (P>0.05). The BIS’s of the cognitive decline group during C_ETSev changing from 0.7% to 2.8% were significantly lower than those of the cognitive intact group (P<0.05). The BIS’s of the cognitive decline group at C_ETSev 0.7%, 1.05%, 1.4% and 1.75% were significantly lower than those of the cognitive intact group (P<0.05), but there were no significant differences at C_ETSev 2.1%, 2.45% and 2.8% between the two groups (P>0.05). Conclusion: During inhaled anesthesia, the BIS of the elderly patients with cognitive decline at loss of consciousness is higher than that of the patients with cognitive intact, The BIS of elderly patients with cognitive decline on deepening of anesthesia is lower than that of the patients with cognitive intact, especially during light anesthesia, and its mechanisms may attribute to cognitive decline related neurodegeneration and neurotransmitter system dysfunction.

Key words: Anesthesia, inhalation, Cognition disorders, Aged

倪诚，戎玉兰，贾东林，李刚，俞晨，李楠，王军，郭向阳. 吸入麻醉对认知功能减退老年患者脑电双频谱指数的影响[J]. 北京大学学报（医学版）, 2013, 45(6): 945-949.

NI Cheng, RONG Yu-lan, JIA Dong-lin, LI Gang, YU Chen, LI Nan, WANG Jun-, GUO Xiang-yang. Influence of inhaled anesthesia on bispectral index of elderly patients with cognitive decline[J]. Journal of Peking University(Health Sciences), 2013, 45(6): 945-949.

参考文献

相关文章 15

[1]	李佳,徐钰,王优雅,高占成. 老年流感肺炎的临床特征及D-二聚体与疾病严重程度的相关性[J]. 北京大学学报（医学版）, 2022, 54(1): 153-160.
[2]	穆东亮,薛铖,安彬,王东信. 硬膜外阻滞与结直肠癌患者术后远期生存状态的关系:一项倾向性评分匹配的回顾性研究[J]. 北京大学学报（医学版）, 2021, 53(6): 1152-1158.
[3]	敖明昕,李学民,于媛媛,时会娟,黄红拾,敖英芳,王薇. 视觉重建对老年人行走动态足底压力的影响[J]. 北京大学学报（医学版）, 2021, 53(5): 907-914.
[4]	彭顺壮, 付茜茜, 冯星淋. 中国中老年居民教育程度与失能发生:社会参与的中介作用[J]. 北京大学学报（医学版）, 2021, 53(3): 549-554.
[5]	张庆芬,赵红,冯艺. 不同全身麻醉管理方式与早产儿眼底手术临床结局[J]. 北京大学学报（医学版）, 2021, 53(1): 195-199.
[6]	陈家丽,金月波,王一帆,张晓盈,李静,姚海红,何菁,李春. 老年发病类风湿关节炎的临床特征及其心血管疾病危险因素分析:一项大样本横断面临床研究[J]. 北京大学学报（医学版）, 2020, 52(6): 1040-1047.
[7]	段登辉,王恩博,崔念晖,翟新利,刘宇,孟娟红,张伟,张益. 下颌阻生智齿拔除手术的可预期微创化[J]. 北京大学学报（医学版）, 2020, 52(2): 395-403.
[8]	王菲,赵阳阳,关明,王晶,许向亮,刘宇,翟新利. 静脉给药镇静技术在2 582例口腔外科门诊手术中的临床应用[J]. 北京大学学报（医学版）, 2020, 52(1): 181-186.
[9]	韩永正,井凤云,徐懋,郭向阳. 颈椎脊索瘤行肿瘤切除术的麻醉管理1例[J]. 北京大学学报（医学版）, 2019, 51(5): 981-983.
[10]	刘鲲鹏,王宝宁,申琰琰,李卫霞,李昭,姚兰. 胸部硬膜外给予利多卡因对双腔气管插管患者血流动力学和唤醒水平的影响[J]. 北京大学学报（医学版）, 2019, 51(4): 742-747.
[11]	陈健,左才红,张财义,杨明,张培训. 解剖型髓内钉和股骨近端防旋髓内钉治疗老年股骨转子间骨折的疗效比较[J]. 北京大学学报（医学版）, 2019, 51(2): 283-287.
[12]	李刚，王健生，秦思达，张佳，杜宁，张靖，孙欣，任宏. 布地奈德联合氨溴索氧化驱动雾化吸入预防成人开胸术后肺炎的临床疗效[J]. 北京大学学报(医学版), 2018, 50(5): 840-844.
[13]	李岩，王辉，邓莹，姚瑶，李民. 静脉输注右美托咪定对臂丛阻滞效果的随机对照研究[J]. 北京大学学报(医学版), 2018, 50(5): 845-849.
[14]	吴小静，李敏，詹庆元. 以高热为表现的外源性脂质性肺炎1例[J]. 北京大学学报(医学版), 2018, 50(5): 921-923.
[15]	李纯青，王东信，韦晓昱. 先天性纤维蛋白原缺乏症产妇的围术期管理：4例报道及文献回顾[J]. 北京大学学报(医学版), 2018, 50(5): 932-936.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed