老年食管癌患者全身麻醉术后认知功能障碍与术中脑氧饱和度变化的关系  

The correlation between regional cerebral oxygen saturation and POCD in older patients undergoing SLV during thoracic surgery

作　　者：丁超[1] 孙莉[1] 张燕[1] 王海[1] 承耀中[1] 赵桂军[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院麻醉科,北京100021

出　　处：《中国医刊》2012年第4期42-44,共3页Chinese Journal of Medicine

摘　　要：目的研究老年食管癌患者全身麻醉术后认知功能障碍(POCD)与术中脑氧饱和度(rSO_2)降低之间的关系。方法随机选取78例年龄大于65岁,拟静吸复合全身麻醉下行左后外切口开胸食管癌根治术的患者,采用双腔支气管导管进行单肺通气(SLV)管理,应用脑氧饱和度监测仪监测从清醒状态到气管拔管阶段的脑氧饱和度(rSO_2)变化,并观察记录脑电双频指数(BIS)和标准监测参数,在对应时间点进行血气分析,所有患者术后均使用静脉镇痛,在术前2天和术后4天采用简易智力状态检查法(MMSE)评估患者认知功能,根据评估结果分为POCD组和非POCD组,进行对比研究。结果 64例老年食管癌患者人组,全身麻醉术后POCD发生率为28.1%(18/64);在SLV期间,rSO_2绝对值低于50%的患者比率为29.7%(19/64),POCD与rSO_2绝对值低于50%具有明显相关性;POCD组的MMSE基线变化率明显大于非POCD组。结论老年食管癌患者术后早期POCD发病率较高,与单肺通气期间脑氧饱和度绝对值低于50%有明显相关性。Objective To study the correlation between regional cerebral oxygen saturation （rSO2 ） changes and POCD in older esophageal cancer patients undergoing SLV during thoracic surgery. Methods Seventy-eight esopha- geal cancer patients participated in this study, age I〉 65 years old, each of whom received general anesthesia and SLV using double-lumen endotracheal tube, rSO2 was measured using INVOS 5100B （Somanetics, Troy, MI, USA） before anesthesia （baseline value） and until SLV was completed. Patient cognitive function was assessed u- sing the mini mental state examination （MMSE） on the day before surgery （baseline） and then repeated 4 days af- ter surgery. The bispectral index （BIS）, standard monitoring parameters and blood gas analysis was observed and recorded at the corresponding time points. The patients were classified into two groups： with （group POCD） and without （ nonPOCD group） POCD during SLV. Cerebral desaturation was defined as a reduction of rSO2 during SLV less than 50%. An intergroup comparison was made between rSO2 findings. We also examined the correlation be- tween the desaturation during SLV and POCD in POCD group patients. Results Sixty-four patients enrolled in the study, Eighteen patients were included in group POCD（28.1% ）, There are 29.7% （19/64） of the patients who rSO2 value less than 50% during SLV. The Cerebral desaturation significantly correlates with POCD （ P 〈 0.05 ）. Conclusions The cerebra[ desaturation during SLV significantly correlates with POCD. Additional studies are nee- ded to determine whether intervention against cerebral desaturation during SLV can prevent POCD.

关 键 词：老年全身麻醉 脑氧饱和度监测 术后认知功能障碍 食管癌 

分 类 号：R743[医药卫生—神经病学与精神病学]