摘要
目的探讨术中调控不同动脉血二氧化碳分压（Pa CO2）对行腹腔镜手术老年患者脑氧代谢和术后认知功能的影响。方法择期全麻下行腹腔镜手术老年患者60例,ASAⅠ-Ⅲ级,将患者随机分为三组各20例：过度通气组（L组）,维持Pa CO230-35 mm Hg;正常通气组（N组）,维持Pa CO235-45 mm Hg;允许性高碳酸血症通气组（H组）,维持Pa CO250-55 mm Hg。于麻醉后气腹前5 min（T0）,气腹60 min（T1）,气腹120 min（T2）,停气腹20 min（T3）,经桡动脉和颈内静脉球部采集血样并行血气分析,记录颈内静脉球部氧饱和度（Sjv O2）,计算脑动-静脉血氧含量差（Ca-jv DO2）和脑动-静脉乳酸含量差（Da-jv Lac）。于术前1天、术后24 h、术后7天采用简易智能状态检查表（MMSE）评分评价术后认知功能。结果三组Dajv Lac无显著差异（P〉0.05）,各组不同监测时间之间Da-jv Lac也无显著差异（P〉0.05）;在T1、T2时刻,与N组比较,H组Ca-jv DO2显著降低,Sjv O2显著增高（P〈0.05）,术后24 h,H组、N组、L组患者的MMSE评分均较术前一天降低（P〈0.05）。结论允许性高碳酸血症机械通气可以改善老年患者术中脑氧代谢和术后认知功能障碍;轻度过度机械通气可增加老年患者术中脑氧代谢。
Objective To investigate the effects of different Pa CO2 modulating during operation on cerebral oxygen metabolism and postoperative cognitive function in elderly patients undergoing laparoscopic surgery. Methods Sixty patients with laparoscopic surgery under general anesthesia（ASA I - Ⅲ） were selected and randomly divided into 3 groups, with 20 cases in each group： normal ventilation group（group N） with the Pa CO2 in the range of 35 - 45 mm Hg during the operation; excessive ventilation group（group L） with Pa CO2 in the range of 30 - 35 mm Hg; permissive hypercapnia ventilation group（group H） with Pa CO2 in the range of 50 - 55 mm Hg. The blood samples were taken from the radial artery and jugular vein for blood gas analyses at T0（5 min before pneumoperitoneum）, T1（60 min after pneumoperitoneum）, T2（120 min after pneumoperitoneum） and T3（20 min after the end of pneumoperitoneum）. At the same time, the O2 suturation of jugular venous blood（Sjv O2） was recorded, and the subtract of arteriovenous oxygen content（Ca-jv DO2） and subtract of arteriovenous lactic acid content（Da-jv Lac） were calculated. Postoperative cognitive function was assessed by mini-mental state examination（MMSE） at 1 day before surgery, 24 hours and 7 days after surgery. Results There was no significant difference in Da-jv Lac among three groups（P〉0.05）, there was also no significant difference of Da-jv Lac between each groups at different monitoring time（P〉0.05）. At T1 and T2, compared with the group N, Ca-jv DO2 was significantly decreased and Sjv O2 was significantly increased in group H（P〈0.05）, Ca-jv DO2 was significantly increased and Sjv O2 was significantly decreased in group L（P〈0.05）; Compared with the baseline date of T0, Ca-jv DO2 was significantly decreased, Sjv O2 was significantly increased at T1 and T2in group H and group N（P〈0.05）, and Sjv O2 was significantly decreased at T2 in group L. There was no significant difference in MMSE score among three
出处
《临床医学工程》
2016年第3期293-295,共3页
Clinical Medicine & Engineering
