小波算法脑电监测下的麻醉管理对老年患者全麻术后恢复质量的影响-东南大学学报医学版

小波算法脑电监测下的麻醉管理对老年患者全麻术后恢复质量的影响

单位：1. 南京医科大学附属常州市第二人民医院麻醉科, 江苏常州 213003;
2. 大连医科大学研究生院辽宁大连 116044

分类号：R614.2

出版年·卷·期（页码）：2023·42·第四期（612-618）

摘要：

目的:探讨小波算法脑电监测下的麻醉管理对老年患者术后恢复质量的影响。方法:选择2022年1月至4月在南京医科大学附属常州市第二人民医院行择期手术的60例患者,年龄60~83岁,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级。随机数字表法将患者分为常规麻醉组(C组)和小波指数(WLI)监测组(W组)。两组患者均采用丙泊酚、舒芬太尼、罗库溴铵静脉快速诱导,术中泵注丙泊酚、瑞芬太尼及吸入七氟烷静吸复合式麻醉维持,间断追加顺式阿曲库铵。C组麻醉医师根据生命体征调整麻醉药物进行术中麻醉管理,并且WLI呈隐蔽状态。W组麻醉医师通过调整静脉麻醉药物的泵注速度或吸入麻醉药物的浓度将WLI维持在35~70之间。记录患者术中收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、血管活性药物用量,术后恢复室(PACU)内拔管时间、VAS评分、改良的Aldrete评分、PACU停留时间,术后24 h内有无恶心呕吐(PONV)。Brice问卷调查评估患者是否存在术中知晓,CAM量表评估患者是否存在术后谵妄(POD),MMSE量表评估患者是否存在术后认知功能障碍(POCD)。结果:两组患者性别、年龄、身高、体质量、体质量指数(BMI)、术前收缩压、舒张压、心率、MMSE评分、ASA分级、受教育程度、手术类型、手术时间、麻醉时间差异均无统计学意义(均P＞0.05)。W组患者SBP＜90 mmHg、SBP＞160 mmHg、MAP≥100 mmHg的发生概率明显低于C组(均P＜0.05),两组患者DBP＜50 mmHg、MAP＜65 mmHg、HR＜45次·min^-1发生概率的差异均无统计学意义(均P＞0.05);W组患者术中麻黄碱用量明显少于C组,差异有统计学意义(P＜0.05),两组患者间羟胺及阿托品的术中用量差异无统计学意义(均P＞0.05);W组术后在PACU 30 min时改良的Aldrete评分明显高于C组(P＜0.05),但两组患者在出室时改良Aldrete评分差异无统计学意义(P＞0.05);两组拔管时间、PACU停留时间、VAS评分差异均无统计学意义(均P＞0.05);W组术后住院期间POD的发生率为3.6%,明显低于C组的23.1%(P＜0.05),W组术后住院时间明显少于C组(P＜0.05),两组患者术后24 h PONV及术后住院POCD发生率的差异均无统计学意义(均P＞0.05)。结论:小波算法脑电监测下的麻醉管理或可提高老年患者全身麻醉术后的恢复质量。

Objective: To explore the effect of anesthesia management under EEG monitoring based on wavelet algorithm on elderly patients after surgery. Methods: A total of 60 patients, aged 60-83 years, falling into American Society of Anesthesiologists(ASA) grade Ⅰ or Ⅱ, who underwent elective surgery in Changzhou Second People's Hospital Affiliated to Nanjing Medical University from January 2022 to April 2022 were selected. Patients were divided into conventional anesthesia group(group C) and wavelet index(WLI) monitoring group(group W) by random number table method. Both groups were rapidly induced by propofol, sufentanil and rocuronium intravenously, and maintained by combined intravenous infusion of propofol, remifentanil and inhalation of sevoflurane during operation, and supplemented with cis-atracurium as needed. In group C, anesthesiologists only performed intraoperative anesthesia management based on clinical experience, and the WLI was kept unknown to the anesthesiologists. In group W, the anesthesiologist maintained the WLI between 35 and 70 by adjusting the infusionrate or concentration of anesthetic drugs. Intraoperative systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP), heart rate(HR), vasoactive drug dosage, extubation time in postoperative recovery room(PACU), VAS score, modified Aldrete score, and PACU stay were recorded. The incidence of nausea and vomiting within 24 hours after surgery(PONV), the presence of intraoperative awareness events by Brice questionnaire, the occurrence of postoperative delirium(POD) by CAM scale and postoperative cognitive dysfunction(POCD) by MMSE scale were evaluated. Results: There were no significant differences in gender, age, height, weight, BMI, preoperative SBP, DBP, HR, MMSE, ASA classification, education level, type of surgery, operation time and anesthesia time between the two groups(all P＞0.05).The incidence of SBP <90 mmHg, SBP＞160 mmHg and MAP≥100 mmHg in group W was significantly lower than that in group C(all P<0.05), but there was no significant difference in the incidence of DBP <50 mmHg, MAP<65 mmHg, HR<45 times·min^-1 and HR ＞100 times·min^-1between the two groups(all P ＞0.05).The intraoperative ephedrine use in group W was significantly lower than that in group C(P<0.05), while the intraoperative dosage of hydroxyamine and atropine was not statistically significant between the two groups(all P＞0.05).The modified Aldrete score in group W was significantly higher than that in group C at 30min PACU after surgery(P<0.05), but there was no significant difference in modified Aldrete score between the two groups at PACU discharge(P＞0.05).There were no significant differences in extubation time, PACU stay and VAS score(all P＞0.05).The incidence of POD in group W during postoperative hospitalization was 3.6%, which was significantly lower than that in group C(23.1%, P<0.05). The duration of postoperative hospitalization in group W was significantly shorter than that in group C(P<0.05). There was no significant difference in the incidence of PONV 24 hours after surgery and POCD in hospital between 2 groups(all P＞0.05). Conclusion: Anesthesia management under EEG monitoring based on wavelet algorithm may improve the quality of postoperative recovery in elderly patients.

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