目的 探讨在每搏变异度(SVV)指导补液的老年结肠癌根治术中,不同BIS值对患者应激反应的影响.方法 将60例静吸复合麻醉下行结肠癌根治术的老年患者随机分为两组(每组n=30):L组(BIS值50~59),D组(BIS值40~49).术中按晶胶比为2:1补液,使SVV维持在8~12.记录患者在入室后20 min(T0)、插管后即刻(T1)、手术开始(T2)、手术开始后60 min(T3)、手术开始后120 min(T4)、手术结束(T5)、拔管后30 min(T6)的心率(HR)、平均动脉压(MAP)的值和心输出量(CO)、每搏量(SV)及SVV在T1、T2、T3、T4、T5时点的值.记录术中补液量及血流动力学波动情况.检测患者T0、T4、T6时点血清皮质醇(Cor)、促肾上腺皮质激素(ACTH)、血糖(Glu)水平.结果 与T0相比,L组患者HR在T4~T6明显增加(P<0.05,P<0.01),MAP在T1、T2显著下降(P<0.05),在T4~T6增加(P<0.05,P<0.01);D组HR各时点无显著变化,MAP在T1~T5下降(P<0.05,P<0.01);同时L组HR在T4~T6明显高于D组(P<0.05),MAP在T3~T6高于D组(P<0.05).D组术中补液量多于L组(P<0.05),高血压发生率低于L组(P<0.05).两组患者Cor、ACTH、Glu在T4、T6均显著升高(P<0.05,P<0.01);L组患者Cor在T4、T6明显高于D组(P<0.05).结论 在SVV指导补液的老年结肠癌根治术中患者麻醉深度维持在BIS值40~49能较好地抑制机体的应激反应,更有利于维持血流动力学的稳定.

Objective To investigate the effects of different depth of anesthesia on ScvO2 and ABL in elderly patients with gastrointestinal cancer. Methods Totally 55 elderly patients undergoing gastrointestinal sur-gery were randomly divided into deep anesthesia group(BIS40-49)(group D,n=27)and light anesthesia group (BIS50-59)(group S,n = 28). While SVV value was fixed,fluid management was conducted while monitoring CVP. HR,MAP,the change of central venous oxygen saturation and lactic acid index were recorded in different time points. Results Propofol dosage in group D and group S indicated statistical significance(P<0.05). ScvO2 in group S in T3~T5 was higher than that in T0 and the difference was statistically significant(P < 0.05). Com-pared with ScvO2 in T3 in group D,that in group S was significantly higher and the difference was statistically sig-nificant(P<0.01),but no significant difference was found in other time point in 2 groups(P>0.05). There was no significant difference between and within ABL groups in each time period(P>0.05). There was no significant difference in terms of other indicators between 2 groups. Conclusions For elderly patients with gastrointestinal surgery,shallow anesthesia can improve tissue oxygenation and reduce the amount of anesthetics.

目的 探讨不同脑电双频指数(BIS)状态下对老年胃肠手术术中炎性因子的影响.方法 选择择期全麻下行胃肠手术的老年患者60例,性别不限,年龄65~75岁,ASA分级Ⅱ或Ⅲ级.按随机数字表法分为两组(n=30):深BIS组(D组)和浅BIS组(L组),D组术中BIS值维持在40~49之间,L组术中BIS值维持在50~59之间,从切皮至术毕通过丙泊酚靶控复合吸入七氟醚调节BIS值在目标值范围,记录麻醉开始(T0)、气管插管后即刻(T1)、切皮(T2)、术中1 h(T3)、术中2 h(T4)、术毕(T5)、拔管后5 min(T6)时的HR、MAP.于T0、T4、T6采中心静脉血2 mL用于检测血清TNF-α和IL-6浓度,记录术中输液量、出血量、尿量、丙泊酚用量、瑞芬太尼用量、麻醉时间和手术时间.结果 L组血浆TNF-α和IL-6的浓度在T6时明显低于D组(P<0.05).组内比较,两组血浆TNF-α的浓度在T6时均较T0时明显升高(P<0.05),两组血浆IL-6的浓度在T4和T6时均较T0时明显升高(P<0.05).L组丙泊酚用量明显少于D组(P<0.05).结论 全麻下老年胃肠道手术患者术中BIS值范围控制在50~59之间时的炎性因子表达水平较BIS值在40~49之间低;术中血流动力学均较平稳,相对较浅的麻醉深度即可满足手术要求,且不会增加炎性因子的释放.