目的探讨术侧肺不同通气方式对老年患者食管癌根治术后早期认知功能的影响。方法择期全身麻醉下拟行食管癌手术患者72例,年龄65~80岁,男女不限,体重45~85kg,ASA分级Ⅰ、Ⅱ级,采用随机数字表法分为3组(每组24例):术侧肺开口于大气组(A组...目的探讨术侧肺不同通气方式对老年患者食管癌根治术后早期认知功能的影响。方法择期全身麻醉下拟行食管癌手术患者72例,年龄65~80岁,男女不限,体重45~85kg,ASA分级Ⅰ、Ⅱ级,采用随机数字表法分为3组(每组24例):术侧肺开口于大气组(A组)、术侧肺持续正压通气组(B组)和术侧肺高频喷射通气组(C组)。麻醉诱导后置入双腔支气管导管,接麻醉机行机械通气。单肺通气期间,A组术侧肺至气管导管开口于大气中,使该侧肺自然萎陷;B组术侧肺持续正压通气,氧流量为2L/min;C组术侧肺行高频喷射通气,通气频率100次/min,驱动压0.5kg/cm^2。于麻醉前(T0)、术毕即刻(T1)、术后6h(T2)、术后12h(T3)和术后24h(T4)抽取颈内静脉血样,测定血清IL-6、TNF-α、S100β蛋白和神经元特异性烯醇化酶(neuronspecific enolase,NSE)的浓度,并于T0、T4、术后3d(T5)和术后7d(T6)采用简易智力状态检查(Mini-Mental State Examination,MMSE)评估认知功能。结果与T0比较,A组和B组血清IL-6、TNF-β、S100β蛋白和NSE浓度在T1~T4时升高(P<0.05),C组血清IL-6、TNF-α、S100β蛋白和NSE浓度在T1~T3时升高(P<0.05),A组MMSE评分在T4~T6时降低,B组和C组MMSE评分在T4、T5时降低(P<0.05);与A组比较,B组和C组血清IL-6、TNF-α、S100β蛋白和NSE浓度在T1~T4时降低,B组和C组MMSE评分在T1-T6时升高(P<0.05);与B组比较,C组血清IL-6、TNF-α、S100β蛋白和NSE浓度在T1-T4时降低,C组MMSE评分在T4-T5时升高(P<0.05)。结论术侧肺进行通气可改善老年患者食管癌根治术后早期认知功能,且术侧肺高频喷射通气对改善老年患者术后早期认知功能的效果更显著。展开更多
Hypoxemia during one-lung ventilation （OLV） is normal. Different ways of improving SpO2 on OLV include intermittent inflation ot the collapsed lung with oxygen, lung recruitment, and application of continuous positi...Hypoxemia during one-lung ventilation （OLV） is normal. Different ways of improving SpO2 on OLV include intermittent inflation ot the collapsed lung with oxygen, lung recruitment, and application of continuous positive airway pressure （CPAP） to the nondependent lung. This case report described the use of CPAP to the right lung, which was converted to high-frequency jet ventilation （HFJV） of the middle and lower lobes during fight upper lobe sleeve resection.展开更多
文摘目的探讨术侧肺不同通气方式对老年患者食管癌根治术后早期认知功能的影响。方法择期全身麻醉下拟行食管癌手术患者72例,年龄65~80岁,男女不限,体重45~85kg,ASA分级Ⅰ、Ⅱ级,采用随机数字表法分为3组(每组24例):术侧肺开口于大气组(A组)、术侧肺持续正压通气组(B组)和术侧肺高频喷射通气组(C组)。麻醉诱导后置入双腔支气管导管,接麻醉机行机械通气。单肺通气期间,A组术侧肺至气管导管开口于大气中,使该侧肺自然萎陷;B组术侧肺持续正压通气,氧流量为2L/min;C组术侧肺行高频喷射通气,通气频率100次/min,驱动压0.5kg/cm^2。于麻醉前(T0)、术毕即刻(T1)、术后6h(T2)、术后12h(T3)和术后24h(T4)抽取颈内静脉血样,测定血清IL-6、TNF-α、S100β蛋白和神经元特异性烯醇化酶(neuronspecific enolase,NSE)的浓度,并于T0、T4、术后3d(T5)和术后7d(T6)采用简易智力状态检查(Mini-Mental State Examination,MMSE)评估认知功能。结果与T0比较,A组和B组血清IL-6、TNF-β、S100β蛋白和NSE浓度在T1~T4时升高(P<0.05),C组血清IL-6、TNF-α、S100β蛋白和NSE浓度在T1~T3时升高(P<0.05),A组MMSE评分在T4~T6时降低,B组和C组MMSE评分在T4、T5时降低(P<0.05);与A组比较,B组和C组血清IL-6、TNF-α、S100β蛋白和NSE浓度在T1~T4时降低,B组和C组MMSE评分在T1-T6时升高(P<0.05);与B组比较,C组血清IL-6、TNF-α、S100β蛋白和NSE浓度在T1-T4时降低,C组MMSE评分在T4-T5时升高(P<0.05)。结论术侧肺进行通气可改善老年患者食管癌根治术后早期认知功能,且术侧肺高频喷射通气对改善老年患者术后早期认知功能的效果更显著。
文摘Hypoxemia during one-lung ventilation （OLV） is normal. Different ways of improving SpO2 on OLV include intermittent inflation ot the collapsed lung with oxygen, lung recruitment, and application of continuous positive airway pressure （CPAP） to the nondependent lung. This case report described the use of CPAP to the right lung, which was converted to high-frequency jet ventilation （HFJV） of the middle and lower lobes during fight upper lobe sleeve resection.
