不同麻醉深度对腹腔镜胆囊切除术老年患者认知功能及应激反应的影响

目的：探讨不同麻醉深度对腹腔镜胆囊切除术老年患者认知功能及应激反应的影响。方法70例老年腹腔镜胆囊切除术患者随机分为两组，每组35例。脑电双频指数（BIS）监测麻醉深度，A组维持术中BIS在50~59，B组40~49。采用简易精神状态量表（MMSE）评估患者术前24 h、拔管后1 h、3 h和24 h的认识功能，并于麻醉前、切皮前、胆囊切除时、拔管后30 min检测患者血清皮质醇（Cor）、血糖（Glu）浓度和C-反应蛋白（CRP）水平。结果两组患者各时间点MMSE评分比较，差异均无统计学意义（t分别=0.41、0.15、0.43， P均＞0.05）；麻醉前两组患者Cor、Glu和CRP水平比较，差异均无统计学意义（t分别=0.37、0.24、0.04，P均＞0.05），但B组患者麻醉后各时间点Cor、Glu和CRP水平均低于A组麻醉后，差异均有统计学意义（t分别=3.87、4.54、3.61、2.47、3.17、3.36、3.65、5.65、6.63，P均＜0.05）。结论维持术中BIS在50~59和40~49对腹腔镜胆囊切除术老年患者认知功能的影响相当，但后者对应激反应抑制效果更好。

Effect of different depth of anesthesia on cognition function and stress reaction in elders with laparoscopic chole-cystectomy

Objective To explore the effect of different depth of anesthesia on cognition function and stress reaction in elders with laparoscopic cholecystectomy. Methods A total of 70 cases of elderly with laparoscopic cholecystectomy were randomly divided into two groups with 35 cases each. The depth of anesthesia was detected by bispectral index（BIS）,and the BIS values were maintaining 50 to 59 in group A and 40 to 49 in group B respectively. Cognitive functions at 24 hours before operarion,3 hours and 24 hours after extubation were evaluated by the minimum mental state examination （MMSE） scale. The serum levels of cortisol（Cor）, glucose（Glu） and C-reaction protein（CRP） were detected at the times of begin-ning of anesthesia, skin incision, gallbladder removaling and 30 minutes after extubation. Results The MMSE scores showed no statistical difference between the two groups at every point （t=0.41,0.15,0.43, P〉0.05）. The level of Cor, Glu and CRP at beginning of anesthesia between two groups were not significantly different（t=0.37, 0.24,0.04, P〉0.05）, but those in group B were lower than group A at times of skin incision, gallbladder removaling and 30 minutes after extubation （t=3.87, 4.54, 3.61, 2.47, 3.17, 3.36, 3.65, 5.65, 6.63, P〈0.05）. Conclusion The effect of maintaining BIS at 50 to 59 and 40 to 49 were similar on cognitive function in elders with laparoscopic cholecystectomy,but the latter for inhibiting stress reaction was better.