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Narcotrend监测不同麻醉深度对肿瘤患者术后认知功能的影响

The Effect of Different Anesthesia Depths on Postoperative Cognitive Function of Tumor Patients Monitored by Narcotrend.

作者信息

Zhao Xueli, Guo Ruina, Ma Xizhong, Hu Zhixun, Liu Jianghong

机构信息

Department of Anesthesiology, The First Hospital of Xingtai, Xingtai, People's Republic of China.

Department of CTMRI, North China Medical Health Group Xingtai General Hospital, Xingtai, People's Republic of China.

出版信息

J Neurol Surg B Skull Base. 2024 May 3;86(3):271-277. doi: 10.1055/s-0044-1786734. eCollection 2025 Jun.

Abstract

The study aimed to examine the influence of different anesthesia depths monitored by Narcotrend on postoperative cognitive dysfunction (POCD) in elderly patients undergoing radical resection of gastrointestinal malignancies.  Individuals in the control group (  = 40) maintained the Narcotrend index (NTI) at 50 to 59 monitored by Narcotrend, whereas the experimental group at 30 to 39. The mini-mental state examination (MMSE) scale and serum S100β concentration were used to evaluate the cognitive function. Cerebral oxygen metabolism and inflammation were evaluated, presenting as regional oxygen saturations of brain (rSO ) and cerebral oxygen uptake rate (CERO2), serum tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6).  Experimental group presented prominently high levels of rSO2 and low levels of CERO2 relative to controls, meanwhile with reduced serum TNF-α and IL-6. Individuals receiving deep anesthesia owned low levels of S100β and enhanced MMSE score, which showed negative correlation. Low incidence rate of POCD was detected in the experimental group. Both age (hazard ratio = 5.219, 95% confidence interval = 1.813-15.025) and NTI score (hazard ratio = 3.707, 95% confidence interval = 1.292-10.633) were independent influence factors for the onset of POCD.  NTI maintained at 30 to 39 can reduce the incidence of POCD in the early postoperative period for elderly patients receiving gastrointestinal tumors surgery, the contribution might be attributed to the improvement of perioperative cerebral oxygen metabolism and inflammatory stress response.

摘要

本研究旨在探讨通过脑电意识深度监测仪(Narcotrend)监测的不同麻醉深度对老年胃肠道恶性肿瘤根治性切除术后认知功能障碍(POCD)的影响。对照组(n = 40)患者通过Narcotrend将脑电意识深度监测指数(NTI)维持在50至59,而实验组维持在30至39。采用简易精神状态检查表(MMSE)和血清S100β浓度评估认知功能。通过脑局部氧饱和度(rSO₂)、脑氧摄取率(CERO₂)、血清肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)评估脑氧代谢和炎症反应。与对照组相比,实验组患者的rSO₂显著升高,CERO₂降低,同时血清TNF-α和IL-6水平降低。接受深度麻醉的患者S100β水平较低,MMSE评分升高,二者呈负相关。实验组POCD发生率较低。年龄(风险比 = 5.219,95%置信区间 = 1.813 - 15.025)和NTI评分(风险比 = 3.707,95%置信区间 = 1.292 - 10.633)均为POCD发生的独立影响因素。将NTI维持在30至39可降低老年胃肠道肿瘤手术患者术后早期POCD的发生率,其作用可能归因于围手术期脑氧代谢和炎症应激反应的改善。

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