不同 Narcotrend 分级指导下全身麻醉对老年腹部手术患者术后认知功能的影响简

目的 探讨不同麻醉趋势（Narcotrend）分级指导下的全身麻醉对老年腹部手术患者术后认知功能的影响.方法 择期全麻下行腹部手术老年患者150例,随机均分为三组（A、B和C组）.以咪达唑仑0.05 mg/kg、丙泊酚1 mg/kg、瑞芬太尼2 μg/kg及罗库溴铵0.6 mg/kg诱导气管插管,术中以瑞芬太尼0.15 μg/（kg·min）、顺式阿曲库铵及丙泊酚维持麻醉.调节丙泊酚泵注速度使A、B、C三组麻醉深度维持至相应水平（D0 64~57、D1 56~47、D2 46~37）.记录手术期间的Narcotrend分级（NT）及指数（NI）,采用BIS作为平行对照.同时记录患者苏醒睁眼时间、拔管时间及各个时间点的心率和血压变化.分别于术前1 d和术后第7天使用简易精神状态量表（MMSE）及蒙特利尔认知功能量表（MoCA）对患者进行认知功能评估.结果 ①A、B和C组患者术后认知功能障碍（POCD）发生率分别为20.8%、15.2%和13.3%,差异无统计学意义（P〉0.05）.②A、B和C组患者术前及术中各个时间点的心率和血压比较差异无统计学意义（P〉0.05）.③三组患者拔管时间有显著差异（P〈0.05）,B比A、C组苏醒拔管快.结论 不同Narcotrend分级指导下全身麻醉对老年患者腹部手术术后认知功能无显著影响,处于D1级麻醉深度时苏醒拔管早.

Influence of dose depth of anesthesia assessed by the Narcotrend index on postoperative cognitive dysfunction in elderly patients after abdominal surgery

Objective To determine among the Narcotrend-assisted anaesthesia in Narcotrend stages D （ general anesthesia） , which level is better than the other on a measurement of postoperative cognitive dysfunction （POCD）. Methods 150 patients were randomized into three groups （A, B, C, n = 50）. Endotracheal intubation was performed with midazolam 0.05 mg/kg, Propofol 1 mg/kg, emifentanil 2 μg/kg,rocuronium 0.6 mg/kg. Propofol and remifentanil were used for maintenance of anaesthesia. The values of the Narcotrend index were recorded continuously. A battery of neuropsychological tests was performed and scored preoperatively and 7 days after operation. Results The rate of POCD was 20.8%, 15.2% and 13.3% of patients in A, B and C group, respectively. There was no difference in hemodynamics among groups at each time point （ P 〉 0.03 ）. The extubation time and recover time have no difference in each group either. Conclusion Guidance of anaesthesia with the Narcotrend-monitor did not able to detect a significant association between the depth of anaesthesia and the rate of POCD 1 week after the surgery.