摘要
目的探讨单肺通气(OLV)手术患者发生术后认知功能障碍(POCD)与局部脑氧饱和度(rSO2)和β-淀粉样蛋白(β-AP)的关系。方法择期需行OLV的胸科手术患者50例,ASAⅠ～Ⅲ级,男29例,女21例,同时选择年龄、性别构成与入选病例相匹配的正常人10例,作为正常对照,分别于术前1天和术后第7天分别行神经心理测验,所有患者于术中持续监测rSO2并计算术中rSO2平均值(rSO2)、术中rSO2最小值(rSO2min)和rSO2较基础值下降的最大百分数(rSO2%max)。于诱导前(T1)、OLV开始(T2)、OLV结束(T3)、术毕24h(T4)抽取颈内静脉血,采用ELISA方法测定β-AP含量。记录术中出血量、尿量、液体输注量。结果共有14例患者发生POCD。T2时非POCD和POCD两组患者rSO2明显高于T1时(P<0.05),POCD组rSO2%max明显高于非POCD组(P<0.05);POCD组T4时β-AP含量明显高于T1时和非POCD组(P<0.01)。POCD组术后第7天MMSE、数字广度(顺背)和数字符号测试得分明显低于术前1天(P<0.05),MMSE和词汇流畅性评分均明显低于非POCD组(P<0.05)。结论 OLV后POCD可能与rSO2下降和β-AP明显升高有关。
Objective To investigate the relations of postoperative cognitive dysfunction （POCD） in one-lung ventilation（OLV） patients with regional cerebral oxygen saturation （rSO2） and β-amyloid protein （13-AP）. Methods Fifty patients scheduled for elective OLV thoracic surgery, ASA physical status Ⅰ-Ⅲ grade, 29 males and 21 females were included in the study, Ten healthy people, sex and age matched with the patients, were included as the control group. In postoperative day 1 and day 7, neuropsychological tests were performed. Intraoperative continuous monitoring of rSO2 was performed and the surgery rSO2 average（rSO2 ）, the minimal surgery rSO2 （rSO2 min） and the maximal percentage of the decreased rSO2 compared to baseline values （rSO2%max） were calculated. Before induction （T1）, OLV start （T2）, OLV end （T3） of operation 24 h （T4）, blood was collected from the internal jugular vein. β-AP content measured by ELISA. Blood loss, urine output and the amount of the infusion were recorded. Results In total 14 patients had POCD. The rSO2 of Tz and Ta of the group POCD, T2 of the group non- POCD was significantly higher than that of T1 （P〈0.05）. The rSO2%max of group POLED was significantly higher than the group non-POCD （P〈0. 05） ; β-AP levels of T4 of the group POCD were significantly higher than T1 and the group non- POCD （P〈0. 01）. Seven days after the MMSE, digit span （cis-back） and digit symbol test scores of the POCD group were significantly lower than the preoperative 1 d （P〈0.05）, MMSE and vocabulary fluency scores were significantly lower than the group non-POCD （P〈0.05）. Conclusion POCD after one-lung ventilation may be associated with the decline in regional cerebral oxygen saturation and the elevation of beta-amyloid protein.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2013年第1期53-56,共4页
Journal of Clinical Anesthesiology
基金
山东省2011年科学技术发展计划(政策引导类)项目(2011YD18070)
关键词
单肺通气
术后认知功能障碍
局部脑氧饱和度
Β-淀粉样蛋白
One-lung ventilation
Postoperative cognitive dysfunction
Regional cerebral oxygen saturation
Beta-amyloid protein
