全麻期间意识监测指数可能有效促进老年患者接受腹腔镜泌尿外科手术后康复：一项随机对照临床试验。
Index of consciousness monitoring during general anesthesia may effectively enhance rehabilitation in elderly patients undergoing laparoscopic urological surgery: a randomized controlled clinical trial.
机构信息
Department of Anesthesiology and Operating Theatre, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, China.
Department of Anesthesiology, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China.
出版信息
BMC Anesthesiol. 2023 Oct 4;23(1):331. doi: 10.1186/s12871-023-02300-z.
BACKGROUND
Based on electroencephalogram (EEG) analysis, index of consciousness (IoC) monitoring is a new technique for monitoring anesthesia depth. IoC is divided into IoC (depth of sedation) and IoC (depth of analgesia). The potential for concurrent monitoring of IoC and IoC to expedite postoperative convalescence remains to be elucidated. We investigated whether combined monitoring of IoC and IoC can effectively enhances postoperative recovery compared with bispectral index (BIS) in elderly patients undergoing laparoscopic urological surgery under general anesthesia.
METHODS
In this prospective, controlled, double-blinded trail, 120 patients aged 65 years or older were arbitrarily assigned to either the IoC group or the control group (BIS monitoring). All patients underwent blood gas analysis at T (before anesthesia induction) and T (the end of operation). The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were administered to all patients at T (1 day before surgery) and T (7 days after surgery). Serum concentrations of C-reactive protein (CRP) and glial fibrillary acid protein (GFAP) were assessed at T, T, and T (24 h after surgery). Postoperative complications and the duration of hospitalization were subjected to comparative evaluation.
RESULTS
The incidence of postoperative cognitive dysfunction (POCD) was notably lower in the IoC group (10%) than in the control group (31.7%) (P = 0.003). Postoperative serum CRP and GFAP concentrations exhibited significant differences at time points T (CRP: P = 0.000; GFAP: P = 0.000) and T (CRP: P = 0.003; GFAP: P = 0.008). Postoperative blood glucose levels (P = 0.000) and the overall rate of complications (P = 0.037) were significantly lower in Group IoC than in Group control.
CONCLUSION
The employment of IoC monitoring for the management of elderly surgical patients can accelerate postoperative convalescence by mitigating intraoperative stress and reducing peripheral and central inflammatory injury.
TRIAL REGISTRATION
Chinese Clinical Trial Registry Identifier: ChiCTR1900025241 (17/08/2019).
背景
基于脑电图（EEG）分析，意识指数（IoC）监测是一种监测麻醉深度的新技术。IoC 分为 IoC（镇静深度）和 IoC（镇痛深度）。同时监测 IoC 和 IoC 以加速术后康复的潜力仍有待阐明。我们研究了在全身麻醉下接受腹腔镜泌尿外科手术的老年患者中，与双谱指数（BIS）相比，联合监测 IoC 和 IoC 是否能有效促进术后恢复。
方法
在这项前瞻性、对照、双盲试验中，120 名年龄在 65 岁或以上的患者被随机分配到 IoC 组或对照组（BIS 监测）。所有患者在 T（麻醉诱导前）和 T（手术结束时）进行血气分析。所有患者在 T（手术前 1 天）和 T（手术后 7 天）进行简易精神状态检查（MMSE）和蒙特利尔认知评估（MoCA）。在 T、T 和 T（手术后 24 小时）评估血清 C 反应蛋白（CRP）和神经胶质纤维酸性蛋白（GFAP）浓度。对术后并发症和住院时间进行比较评价。
结果
IoC 组（10%）术后认知功能障碍（POCD）的发生率明显低于对照组（31.7%）（P=0.003）。术后血清 CRP 和 GFAP 浓度在时间点 T（CRP：P=0.000；GFAP：P=0.000）和 T（CRP：P=0.003；GFAP：P=0.008）有显著差异。IoC 组术后血糖水平（P=0.000）和总并发症发生率（P=0.037）明显低于对照组。
结论
IoC 监测用于老年手术患者的管理，可以通过减轻术中应激和减少外周和中枢炎症损伤来加速术后康复。
试验注册
中国临床试验注册中心标识符：ChiCTR1900025241（2019 年 8 月 17 日）。
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