|
| 丙泊酚与七氟醚对术后神经认知恢复延迟的影响及脑状态指数的预测价值 |
| Effect of propofol and sevoflurane on delayed postoperative neurocognitive recovery and predictive value of cerebral state index |
| |
| DOI：10.12089/jca.2025.10.008 |
| 中文关键词: 老年 脑状态指数 神经认知恢复延迟 全身麻醉 术后认知功能 |
| 英文关键词: Aged Cerebral state index Delayed neurocognitive recovery General anesthesia Postoperative cognitive function |
| 基金项目:山西省回国留学人员科研资助项目（2021-170） |
|
| 摘要点击次数: 1365 |
| 全文下载次数: 372 |
| 中文摘要: |
目的：探讨丙泊酚与七氟醚对老年患者术后神经认知恢复延迟（dNCR）的影响，并探讨脑状态指数（CSI）对dNCR的预测价值。
方法：选择2023年8月至2024年8月行腹腔镜胆囊切除术的老年患者102例，男41例，女61例，年龄65～85岁，BMI 18.5～30.0 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为两组：丙泊酚组（P组）与七氟醚组（S组），每组51例。麻醉维持：P组泵注丙泊酚4～8 mg·kg-1·h-1，S组吸入0.6～1.5 MAC七氟醚。记录术前1 d、术后1、3、7、30 d中国改良版蒙特利尔认知评估量表（MoCA）评分。记录术后1、3、7、30 d dNCR的发生情况。于术前1 d、术后1、3 d使用脑电波感知头戴并记录CSI。采用多因素Logistic回归分析dNCR的影响因素，受试者工作特征曲线（ROC）分析评估效能，并计算曲线下面积（AUC）。
结果：与S组比较，P组术后1、3、7 d MoCA评分明显升高，术后1、3 d dNCR发生率明显降低，术后1、3 d脑混沌、脑惰性、内专注评分明显降低，术后1 d脑内敛、脑稳定、反应速度评分明显升高，术后3 d脑内敛、记忆加工评分明显升高（P＜0.05）。多因素Logistic回归分析结果显示，术后1 d脑混沌、脑惰性是dNCR的独立危险因素，脑内敛、反应速度是dNCR的独立保护因素；术后3 d脑惰性是dNCR的独立危险因素，脑内敛、脑耗能是dNCR的独立保护因素。基于这些因素构建预测模型，术后1 d预测模型AUC为0.953（95%CI 0.916～0.989），敏感性为0.871，特异性为0.915；术后3 d预测模型AUC为0.952（95%CI 0.910～0.994），敏感性为0.885，特异性为0.908。
结论：丙泊酚全凭静脉麻醉术后dNCR的发生率低于七氟醚吸入麻醉，CSI对dNCR具有良好的预测价值。 |
| 英文摘要: |
Objective: To investigate the influence of propofol and sevoflurane on delayed postoperative neurocognitive recovery (dNCR) in elderly patients and to investigate the predictive value of brain state index (CSI) for dNCR.
Methods: A total of 102 elderly patients who underwent elective laparoscopic cholecystectomy from August 2023 to August 2024 were selected, 41 males and 61 females, aged 65-85 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ-Ⅲ. The patients were divided into two groups by random number table method: propofol group (group P) and sevoflurane group (group S), 51 patients in each group. Anesthesia maintenance in group P was pumping propofol 4-8 mg·kg-1·h-1, while in group S was inhaling 0.6-1.5 MAC sevoflurane. The Chinese modified Montreal cognitive assessment (MoCA) scores of the patients were recorded 1 day before surgery, 1 day, 3, 7, and 30 days after surgery. The occurrence of dNCR 1 day, 3, 7, and 30 days after surgery was recorded. The CSI of the patients was recorded using an electroencephalogram perception headset 1 day before surgery, 1 day and 3 days after surgery. Multiple Logistic regression was used to analyze influencing factors, receiver operating characteristic (ROC) curve was used to evaluate efficacy, and area under curve (AUC) was calculated.
Results: Compared with group S, the MoCA scores were significantly increased 1 day, 3, and 7 days after surgery, the incidence of dNCR 1 day and 3 days after surgery was significantly decreased, brain chaos, brain inertia, and internal focus 1 day and 3 days after surgery were significantly decreased, brain introversion, brain stability, and reaction speed 1 day after surgery were significantly increased, brain introversion and memory processing 3 days after surgery were significantly increased (P < 0.05). Multivariate logistic regression analysis showed that, brain chaos and brain inertia 1 day after surgery were independent risk factors of dNCR, while brain introversion and reaction speed 1 day after surgery were independent protective factors of dNCR. Brain inertia 3 days after surgery was an independent risk factor of dNCR, while brain introversion and brain energy consumption 3 days after surgery were independent protective factors of dNCR. Based on these factors, predictive models were constructed, the AUC of the predictive models 1 day after surgery was 0.953 (95% CI 0.916-0.989), the sensitivity was 0.871, and the specificity was 0.915. While the AUC of the predictive models 3 days after surgery was 0.952 (95% CI 0.910-0.994), the sensitivity was 0.885, and the specificity was 0.908.
Conclusion: The incidence of dNCR after total intravenous anesthesia with propofol is lower than that after inhalation anesthesia with sevofluranein elderly patients, and CSI has a good predictive value for dNCR. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
