山东医药2025，Vol.65Issue(4)：78-82,5.DOI:10.3969/j.issn.1002-266X.2025.04.016
局部脑氧饱和度监测目标导向管理对行腹腔镜肝切除术老年肝癌患者术后认知功能的影响
Effect of goal-directed management based on regional cerebral oxygen saturation monitoring on postoperative cognitive function in elderly patients with hepatocellular carcinoma undergoing laparoscopic hepatectomy
摘要
Abstract
Objective To observe the effect of goal-directed management based on regional cerebral oxygen satura-tion(rSO2)monitoring on postoperative cognitive function in elderly patients with hepatocellular carcinoma undergoing lap-aroscopic hepatectomy.Methods Sixty elderly patients with hepatocellular carcinoma undergoing laparoscopic hepatec-tomy were selected and randomly divided into the observation group and control group with 30 cases in each group.Anes-thesia in the observation group was adjusted according to rSO2 value during operation,while anesthesia in the control group was performed according to anesthesiologist experience.The incidence of perioperative neurocognitive disorders(PND)and the score of the Mini-Mental State Examination Scale(MMSE)before and after surgery(1 d before and 1 and 3 d after surgery)were recorded.Serum neuron-specific enolase(NSE)and S100 calc-binding protein β subtype(S100β)were de-tected by enzymed-linked immunosorbent assay(ELISA)before and after surgery(1 d before and 1 and 3 d after surgery).Mean arterial pressure(MAP),heart rate(HR),rSO2 and cerebral state index(CSI)were recorded at different time points[before anesthesia induction(T0),5 min after anesthesia induction(T1),1 h after surgery(T2),after surgery(T3),and at extubation(T4)].The baseline rSO2(rSO2baseline),the minimum rSO2(rSO2min)during operation,the mean rSO2(rSO2mean),and the maximum percentage of rSO2 decrease from baseline(rSO2%max)were also recorded.Serum C-reac-tive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor α(TNF-α)were detected by enzyme-linked immuno-sorbent assay.Results Compared with the control group,the incidence of PND in the observation group decreased at 1 and 3 d after operation(P<0.05).Compared with the control group,the MMSE score and serum NSE and S100β levels in the observation group increased at 1 d after surgery,and serum NSE and S100β levels decreased at 3 d after surgery(all P<0.05).Compared with the same group at 1 d before surgery,MMSE scores of two groups at 1 and 3 d after surgery de-creased and serum NSE,S100β levels increased(all P<0.05).Compared with the control group,MAP and rSO2 at T2 and T3 increased in the observation group(all P<0.05).Compared with those at T0 in the same group,MAP and rSO2 de-creased at T1,T2 and T3,while HR and CSI decreased at T1,T2,T3 and T4 in the two groups(all P<0.05).Compared with the control group,rSO2min and rSO2mean increased,and rSO2mean and rSO2%max decreased in the observation group(all P<0.05).Compared with the control group,serum CRP,IL-6 and TNF-α levels in the observation group decreased at 1 and 3 d after operation(all P<0.05).Compared with the same group at 1 d before surgery,serum CRP,IL-6 and TNF-α lev-els increased in the two groups at 1 and 3 d after surgery(all P<0.05).Conclusion Goal-directed management based on rSO2 monitoring can improve postoperative cognitive function,reduce PND occurrence,brain injury,and inflammation level in elderly patients with hepatocellular carcinoma undergoing laparoscopic hepatectomy,and the anesthetic effect is stable.关键词
局部脑氧饱和度/腹腔镜肝切除术/肝癌/认知功能/围手术期神经认知障碍Key words
regional cerebral oxygen saturation/laparoscopic hepatectomy/liver carcinoma/cognitive function/perioperative neurocognitive disorders分类
临床医学引用本文复制引用
周兴,杨吉安,彭凡凡,何丽丽,刘媛媛,何军民,马晓兰,任志艳,杨培豪..局部脑氧饱和度监测目标导向管理对行腹腔镜肝切除术老年肝癌患者术后认知功能的影响[J].山东医药,2025,65(4):78-82,5.基金项目
湖北省荆门市科学技术研究与开发计划项目(2021YFYB021). （2021YFYB021）
