摘要
目的:探讨压力控制机械通气模式对颅内动脉瘤夹闭术患者术后认知功能的影响及其可能机制。方法:选取2019年11月-2021年11月在内蒙古科技大学包头医学院第一附属医院行颅内动脉瘤夹闭术患者60例,采用随机数字表法分为容量控制通气模式(VCV)组(V组)和压力控制通气(PCV)组(P组),每组30例。在全身麻醉诱导后V组采用容量控制通气,P组采用压力控制通气模式。术中根据P_(ET)CO_(2)调整患者相关呼吸参数。选取六个时间点:麻醉诱导前(T_(0)),气管插管后(T_(1))、手术开始后(T_(2))、手术开始后60 min(T_(3))、手术开始后120 min(T_(4))和手术结束拔管后(T_(5))。在所有时间点均记录HR、MAP和BIS;在T_(1)~T_(4)记录Ppeak、Pmean、Pplat、MV和P_(ET)CO_(2);T_(0)和T_(5)抽取静脉血,测定血清中TNF-α、IL-6的含量;于术前1 d和术后1、3、7 d采用MoCA量表进行认知功能测定。结果:两组T_(1)~T_(4)BIS均明显低于同组T_(0)和T_(5),差异均有统计学意义(P<0.05)。P组T_(1)、T_(2)、T_(3)、T_(4)的Pmean、Ppeak、Pplat均小于V组,差异均有统计学意义(P<0.05);两组患者T_(2)、T_(3)、T_(4)的Pmean、Ppeak、Pplat均高于T_(1),差异均有统计学意义(P<0.05)。两组患者T_(5)的IL-6、TNF-α均高于T_(1),差异均有统计学意义(P<0.05);P组患者T_(5)的IL-6和TNF-α均低于V组,差异均有统计学意义(P<0.05)。术后1、3、7 d,P组MoCA评分均高于V组,差异均有统计学意义(P<0.05)。结论:与容量控制通气模式相比,压力控制通气模式可降低行颅内动脉瘤夹闭术患者术后认知功能影响。其可能机制是,压力控制通气模式可以通过降低气道压来减轻气体压力对肺部造成的损伤,从而降低患者血清中促炎因子TNF-α和IL-6水平,降低对认知功能的影响。
Objective:To investigate the effect of pressure-controlled mechanical ventilation mode on postoperative cognitive function and possible mechanisms in patients with intracranial aneurysm clipping.Method:From November 2019 to November 2021,60 patients who underwent intracranial aneurysm clipping in the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology were selected.The patients were randomly divided into volume controlled ventilation(VCV)group(group V)and pressure controlled ventilation(PCV)group(group P),with 30 cases in each group.After induction of general anesthesia,volume-controlled ventilation was used in group V;pressure-controlled ventilation was used in group P.During the operation,relevant respiratory parameters of patients were adjusted according to P_(ET)CO_(2).Six time points were selected:before induction of anesthesia(T_(0)),after endotracheal intubation(T_(1)),after surgery(T_(2)),60 minutes after surgery(T_(3)),120 minutes after surgery(T_(4)),and after extubation after surgery(T_(5)).HR,MAP and BIS were recorded at all time points.Respiratory mechanics indexes were recorded at four time points T_(1)-T_(4),Peak,Pmean,Pplat,MV and P_(ET)CO_(2).Venous blood was drawn at T_(0) and T_(5),and the levels of TNF-αand IL-6 in serum were determined.MoCA scale was used to measure cognitive function at 1 day before operation and 1,3,7 days after operation.Result:BIS of T_(1)-T_(4) in two groups were significantly lower than those of T_(0) and T_(5) in the same group,the differences were statistically significant(P<0.05).The Pmean,Ppeak and Pplat of T_(1),T_(2),T_(3) and T_(4) in group P were lower than those in group V,the differences were statistically significant(P<0.05);the Pmean,Ppeak and Pplat of T_(2),T_(3) and T_(4) in two groups were higher than those of T_(1),the differences were statistically significant(P<0.05).The levels of IL-6 and TNF-αin T_(5) were higher than those in T_(1),the differences were statistically significant(P<0.05);the lev
作者
李晓梅
李荣
LI Xiaomei;LI Rong(Graduate School of Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou 014010,China;不详)
出处
《中国医学创新》
CAS
2022年第29期109-114,共6页
Medical Innovation of China
关键词
压力控制通气
容量控制通气
术后认知功能
颅内动脉瘤夹闭术
Pressure-controlled ventilation
Volume-controlled ventilation
Postoperative cognitive function
Intracranial aneurysm clipping
