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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
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曹远均,董击夫.不同麻醉深度对老年幕上肿瘤切除术患者术中乳酸和葡萄糖及术后早期认知功能的影响[J].中华老年多器官疾病杂志,2020,19(12):910~913
不同麻醉深度对老年幕上肿瘤切除术患者术中乳酸和葡萄糖及术后早期认知功能的影响
Effects of different anesthesia depths on intraoperative lactate and glucose and postoperative cognitive function in elderly patients undergoing supratentorial tumor resection
投稿时间:2020-02-27  
DOI:10.11915/j.issn.1671-5403.2020.12.209
中文关键词:  麻醉深度;幕上肿瘤切除术;葡萄糖摄取率;乳酸生成率;术后认知
英文关键词:anesthesia depth; supratentorial tumor resection; glucose extraction rate; lactate production rate; postopera-tive cognitive Corresponding author:DONG Ji-Fu, E-mail:dongjifu610041@163.com〖FL
基金项目:
作者单位E-mail
曹远均 九〇三医院麻醉科,四川 江油 621700 dongjifu610041@163.comeffects 
董击夫 电子科技大学医学院附属肿瘤医院·四川省肿瘤医院麻醉医学中心,成都 610041 dongjifu610041@163.comeffects 
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中文摘要:
      研究不同麻醉深度对幕上肿瘤切除术老年患者术中葡萄糖、乳酸及术后早期认知功能的影响。方法 选取2017年2月至2019年6月在九〇三医院和四川省肿瘤医院行幕上脑肿瘤切除术的120例老年患者为研究对象,按照麻醉深度分为3组,脑电双频(BIS)指数监护仪监测麻醉深度,A组BIS指数30~39、B组BIS指数40~49、C组BIS指数50~59,每组40例。诱导前(T1)、气管插管即刻(T2)、分离肿瘤时(T3)、切除肿瘤时(T4)、缝硬脑膜时(T5)同步采集颈内静脉球部和桡动脉血测定血糖和乳酸含量,并计算脑能量代谢指标葡萄糖摄取率(GluER)和脑乳酸生成率(LacPR)。术后第1、3、7天时,采用简易精神状态检查量表(MMSE)评价认知功能,另取3ml静脉血应用酶联免疫吸附法测定S100β蛋白和神经元特异性烯醇化酶(NSE)。数据采用SPSS 19.0软件分析,多组间比较采用方差分析,2组间比较采用LSD-t检验。结果 A组和C组患者麻醉诱导后的各时间点与T1相比,GluER明显降低,差异均有统计学意义(均P<0.05),而B组患者GluER在诱导前后均无差异(均P>0.05);与T1相比,B组患者LacPR在T2~T5时逐渐降低(P<0.05),而A组和C组无差异(均P>0.05)。术后第1、3、7天时,与A组和C组相比,B组患者的MMSE评分均明显升高(均P<0.05),而血清S100β蛋白及NSE水平明显降低(P<0.05)。结论 BIS指数40~49的麻醉深度能够控制幕上肿瘤切除术中老年患者的脑代谢,维持血糖平衡,降低LacPR,从而改善术后认知功能。
英文摘要:
      Objective To investigate the effects of different anesthesia depths on intraoperative glucose and lactate and postoperative cognitive function in elderly patients undergoing supratentorial tumor resection. Methods Totally 120 elderly patients undergoing supratentorial tumor resection admitted to 903 Hospital and Sichuan Provincial Cancer Hospital from February 2017 to June 2019 were selected and divided into group A (n=40) with bispectral (BIS) index 30-39, group B (n=40) with BIS index 40-49, and group C (n=40) with BIS index 50-59. Blood samples were taken from radial artery and jugular venous bulb simultaneously before induction of anesthesia (T1), at the intubation (T2), during separation (T3), at removal (T4), and at the closure of dura (T5). Glucose extraction rate (GluER) and cerebral lactate production rate (LacPR) were measured. At D1, D3 and D7, mini-mental state examination (MMSE) was adopted to evaluate cognitive function, and the serum S100β and neuron-specific enolase (NSE) were measured. Data were analyzed using SPSS statistics 19.0. Analysis of variance was used between multiple groups, and comparisons between the two groups were performed using LSD-t test. Results Compared with T1, GluER was significantly reduced at each time point after induction in group A and group C (all P<0.05), while GluER in group B had no difference before and after induction (all P>0.05). Compared with T1, the LacPR of group B decreased gradually from T2 to T5 (P<0.05), but there was no difference in the LacPR of group A and C (both P>0.05). At D1, D3 and D7, MMSE scores of group B were significantly higher than those of the other two groups (P<0.05), while serum S100β and NSE of the group B was significantly lower than those of the other two groups (P<0.05). Conclusion The anesthesia depth with BIS index 40-49 can control cerebral metabolism in the elderly patients undergoing supratentorial tumor resection, maintain blood glucose balance, and reduce LacPR, thereby improving postoperative cognitive function.
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