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.

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