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  

Effects of different modes of ventilation of lung on operated side on early postoperative cognitive function in elderly patients undergoing radical surgery for esophageal carcinoma

作　　者：刘萍 张敏 刘云 张玲 黄红 张承华[3] Liu Ping;Zhang Min;Liu Yun;Zhang Ling;Huang Hong;Zhang Chenghua(Department of Anesthesiology,the Third People's Hospital of Yunnan Province,Kunming 650011,China;Department of Neurology,the Third People's Hospital of Yunnan Province,Kunming 650011,China;Department of Anesthesiology,Kunming General Hospital of the PLA,Kunming 650032,China)

机构地区：[1]云南省第三人民医院麻醉科,昆明650011 [2]云南省第三人民医院神经内科,昆明650011 [3]解放军昆明总医院麻醉科,650032

出　　处：《国际麻醉学与复苏杂志》2018年第11期1016-1020,共5页International Journal of Anesthesiology and Resuscitation

基　　金：成都军区医学科学技术研究计划项目(C12055).

摘　　要：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。Objective To evaluate the effects of different modes of ventilation of lung on operated side on early postoperative cognitive function in elderly patients undergoing radical surgery for esophageal carcinoma. Methods Seventy-two ASAⅠorⅡelderly patients of both sexes, aged 65-80 y, weighing 45-85 kg, scheduled for elective radical resection for esophageal cancer and were randomly divided into 3 groups (n=24) using a random number table: group A, group B and group C. After induction of anesthesia, the patients were intubated with double-lumen tube and one-lung ventilation was performed. During one-lung ventilation, the lung on the operated side was collapsed naturally in group A, positive pressure ventilation (fresh gas flow 2 L/min) was applied in the lung on the operated side in group B, and high-frequency jet ventilation (frequency 100 bpm, driving pressure 0.5 kg/cm2) was used in the lung on the operated side in group C. The blood samples were obtained before induction (T0), at the end of operation (T1), on 6 h (T2), 12 h (T3) and 24 h (T4) after operation for determination of plasma concentration of S100β protein, neuron-specific enolase (NSE), IL-6 and TNF-α. The Mini-Mental State Examination (MMSE) was used to test the cognitive function of the patients at T0, T4, 3 d (T5) and 7 d after operation (T6). Results Compared with the baseline value at T0, the plasma concentrations of IL-6, TNF-α, S100β protein and NSE in group A and group B were increased at T1-T4, the plasma concentrations of IL-6, TNF-α, S100β protein and NSE in group C were increased at T1-T3, the MMSE score in group A were decreased at T4-T6, the MMSE score in group B and group C were decreased at T4-T5(P<0.05). Compared with group A, the plasma concentrations of IL-6, TNF-α, S100β protein and NSE in group B and group C were decreased at T1-T4, the MMSE score in group B and group C were increased at T4-T6(P<0.05). Compared with group B, the plasma concentrations of IL-6, TNF-α, S100β protein and NSE in group C were decreased at T1

关 键 词：连续气道正压通气 高频喷射通气 老年人 认知障碍 

分 类 号：R614[医药卫生—麻醉学] R735.1[医药卫生—外科学]