过度通气对糖尿病病人脑氧供需平衡的影响  

The effects of hyperventilation on the balance of cerebral oxygen supply and demand in patients with diabetes mellitus under general anesthesia

作　　者：林成新[1] 蒋宗滨[1] 何文政[1] 王喜军[1] 李英英[1] 胡振快[1] 

机构地区：[1]广西医科大学第一附属医院麻醉科,南宁市530021

出　　处：《临床麻醉学杂志》2005年第5期303-305,共3页Journal of Clinical Anesthesiology

基　　金：广西壮族自治区卫生厅医疗卫生科研课题(Z2002020)

摘　　要：目的研究过度通气对手术中糖尿病病人脑氧供需平衡的影响。方法择期全麻下行腹部手术病人30例,2型糖尿病组15例(DM组),非糖尿病组15例(对照组,C组),所有病人术中均随机分别进行三种不同模式机械通气:正常通气量通气[模式Ⅰ,动脉血二氧化碳分压(PaCO2)维持在35~40mmHg]、轻度过度通气(模式Ⅱ,PaCO2维持在30~35mmHg)、中度过度通气(模式Ⅲ,PaCO2维持在25~30mmHg),检测两组病人在三种不同通气模式下动脉血氧饱和度(SaO2)、动脉血氧分压(PaO2)、动脉血乳酸盐浓度(ABL)、颈内静脉血氧饱和度(SjvO2)、颈内静脉血氧分压(Pj-vO2)和颈内静脉血乳酸盐浓度(JVBL),并计算病人在不同通气模式下动脉血氧含量(CaO2)、颈内静脉血氧含量(CjvO2)、氧摄取率(CERO2)和颈内静脉与桡动脉血乳酸差(DLA-V)。结果两组病人CjvO2和SjvO2在以模式Ⅲ通气时均明显低于以模式Ⅰ通气,CERO2在模式Ⅲ通气时明显高于以模式Ⅰ通气。DM组病人JVBL和DLA-V在模式Ⅲ通气时均明显高于以模式Ⅰ通气。中度过度通气时,DM组病人DLA-V高于C组。结论中度过度通气可影响2型糖尿病病人脑氧供需平衡,导致大脑组织乏氧代谢增加。Objective To investigate the effects of hyperventilation on the balance of cerebral oxygen supply and demand in patients with diabetes mellitus(DM) under general anesthesia.Methods^Thirty patients undergoing abdominal surgery under general anesthesia were selected.15 patients suffered from type 2 DM (group DM),and 15 patients were non-diabetic patients(group C). Three models of mechanical ventilation were performed randomly during the procedures: normal mechanical ventilation(model Ⅰ,PaCO_2 was kept in 35-40 mmHg), slight hyperventilation (model Ⅱ, PaCO_2 was kept in 30-35 mmHg),moderate hyperventilation (model Ⅲ, PaCO_2 was kept in 25-30 mmHg).Arterial oxygen saturation (SaO_2),arterial partial pressure of oxygen (PaO_2), arterial blood lactate (ABL),jugular venous oxygen saturation (SjvO_2), jugular venous partial pressure of ~oxygen (PjvO_2) and jugular venous blood lactate (JVBL) were detected during mechanical ventilation.Content of arterial blood oxygen (CaO_2 ), content of jugular venous oxygen (CjvO_2 ), Cerebral oxygen extraction rate (CERO_2 ), and difference of arterial and jugular venous blood lactate (DL_~ A-V ) were calculated at the same time.Results The values of ~CjvO_2 and SjvO_2 in method Ⅲ were significantly lower than those in model Ⅰ in two groups(P<0.05).The value of CERO_2 in method Ⅲ was significantly higher than that in method Ⅰ in two groups(P<0.05).The values of JVBL and DL_~A-V in model Ⅲ were significantly higher than those in model Ⅰ in DM group(P<0.01).The values of CjvO_2, SjvO_2, CERO_2, and JVBL had no significant differences between two groups.The value of DL_~A-V in DM group was significantly higher than that in group C in model Ⅲ(P<0.05).Conclusion Moderate hyperventilation can effect the balance of cerebral oxygen supply and demand in DM patients under general anesthesia,and increase anaerobic metabolism.

关 键 词：过度通气 糖尿病 脑氧供需平衡 脑组织 

分 类 号：R587.1[医药卫生—内分泌]