机构地区:[1]合肥市第二人民医院麻醉科,安徽合肥230011
出 处:《中国现代手术学杂志》2018年第3期231-235,共5页Chinese Journal of Modern Operative Surgery
摘 要:目的观察Supreme喉罩间歇正压机械通气(intermittent positive pressure ventilation,IPPV)对老年患者脑氧代谢及术后认知功能的影响。方法择期全麻下行四肢及下腹部手术的老年患者50例,年龄65~85岁,ASA分级Ⅰ~Ⅲ级,采用随机数字表法将患者随机分为2组:S组(25例),置入Supreme喉罩;E组(25例),行气管插管术。两组于气管插管或置入Supreme喉罩前(T0)、气管插管或置入Supreme喉罩间歇正压机械通气后30 min(T1)和60 min(T2)时经桡动脉、颈内静脉球部采集血样行血气分析,计算动脉-颈内静脉血氧含量差(Da-jvO_2)和脑氧摄取率(CERO_2)。采用简易智能状态检查表(MMSE)法,在术前1 d、术后24 h、48 h、1周、2周时对所有患者进行术后认知功能评估,判定并计算术后认知功能障碍发生率。结果组内比较:与T0时相比,S组T1、T2时颈内静脉血氧饱和度(SjvO_2)降低,Da-jvO_2和CERO_2升高(P<0.05);与术前1 d相比,两组术后24 h、48 h、1周MMSE评分均降低(P<0.05)。组间比较:S组T1、T2时较E组SjvO_2降低,Da-jvO_2和CERO_2升高,均有统计学差异(P<0.05);两组术后各时点MMSE评分及术后认知功能障碍发生率比较,差异均无统计学意义(P>0.05)。结论 Supreme喉罩间歇正压机械通气可增加老年患者脑氧代谢率,但在正常范围内,且不增加术后认知功能障碍发生率,提示无脑组织缺氧发生。Objective To investigate the effect of intermittent positive pressure ventilation( IPPV) with supreme laryngeal mask airway on cerebral oxygen metabolism and postoperative cognitive function in elderly patients. Methods Adopting the method of random number table,fifty old patients with ASA Ⅰto Ⅲ,aged from 65 to 85 years old,undergoing selective limbs and lower abdominal surgery under general anesthesia,were equally randomized into 2 groups: group S was placed supreme laryngeal mask airway and group E was performed endotracheal intubation. Blood samples were taken from the radial artery and internal jugular vein bulb for blood gas analyses before tracheal intubation or Supreme laryngeal mask airway insertion( T0) and at 30 min( T1) and 60 min( T2) after IPPV. Cerebral arterio-jugular difference of oxygen( Da-jvO_2) and cerebral oxygen extraction rate( CERO_2) were calculated. Cognitive function was assessed by Mini-Mental State Examination( MMSE) 1 day before operation and 24 h,48 h,1 week and 2 weeks after the operation,and the incidence of post-operative cognitive dysfunction was calculated. Results Compared with T0,The jugular venous oxygen saturation( SjvO2) was significantly decreased and Da-jvO_2 and CERO_2 were increased at T1 and T2 in group S( P〈0. 05). Compared with 1 day before operation,MMSE score was significantly decreased at24 h,48 h and 1 week after operation in both groups( P〈0. 05). At T1 and T2,SjvO_2 was lower,and Da-jvO_2 and CERO_2 were higher in group S than those in group E,and the differences were statistically( P〈0. 05).There was no statistical difference in MMSE score and the incidence of post-operative cognitive dysfunction at each time point between the two groups( P〉0. 05). Conclusions Intermittent positive pressure ventilation with Supreme laryngeal mask airway can increase the cerebral oxygen metabolism rate during operation in elderly patients,and does not increase the incidence of post-operative cognitive dysfunction. T
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