围术期体温保护对老年胃肠手术患者脑氧代谢及氧化应激的影响  

Influences of perioperative temperature protection on brain oxygen metabolism and oxidative stress in the elderly patients with gastrointestinal surgery

作　　者：马琨[1] 米梅艳[2] 马朋羽[3] 杨运亮[3] 赵建辉[3] MA Kun;MI Meiyan;MA Pengyu;YANG Yunliang;ZHAO Jianhui(Department of Anaesthesiology,the Fourth Hospital of Shijiazhuang,Hebei Province,Shijiazhuang 050011,China;Shijiazhuang Fourth Hospital Women Division,Hebei Province,Shijiazhuang 050011,China;Department of Anaesthesiology,the First Hospital of Shijiazhuang,Hebei Province,Shijiazhuang 050011,China)

机构地区：[1]石家庄市第四医院麻醉科,河北石家庄050011 [2]石家庄市第四医院妇二科,河北石家庄050011 [3]石家庄市第一医院麻醉科,河北石家庄050011

出　　处：《中国医药导报》2018年第25期91-95,共5页China Medical Herald

基　　金：河北省石家庄市科学技术研究与发展指导计划项目(171462333)

摘　　要：目的探讨围术期体温保护对老年胃肠手术患者脑氧代谢及氧化应激的影响。方法回顾性分析2016年1月~2017年11月石家庄市第四医院收治的行胃肠手术的105例老年患者的临床资料,将其中采用围术期常规处理的设为常规组(51例),采用围术期常规+保温处理的设为研究组(54例)。比较麻醉前(T_1)、手术开始后15 min(T_2)、手术结束即刻(T_3)及术后2 h(T_4)的体温(Temp)、心率(HR)与平均动脉压(MAP);对比颈内静脉内血氧分压(PjvO_2)、颈内静脉血氧饱和度(SjvO_2)、颈内静脉血氧含量(CjvO_2)、颈静脉血乳酸(JVL)及血清丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)水平;观察寒颤、烦躁发生情况及术后苏醒时间。结果研究组Temp、HR及MAP各数值均无明显波动(P>0.05),常规组T_2、T_3、T_4时点均明显低于T_1时点(P<0.05),常规组T_3、T_4时点均明显低于T_2(P<0.05);除T_1外,研究组Temp均明显高于常规组(P<0.05),HR与MAP均明显低于常规组(P<0.05);除T_1外,研究组PjvO_2、SjvO_2、CjvO_2、SOD及GSH-Px均明显高于常规组(P<0.05),JVL及MDA均明显低于常规组(P<0.05);研究组寒颤及烦躁发生率均明显低于常规组(P<0.01),术后苏醒时间明显短于常规组(P<0.01)。结论围术期体温保护有利于维持老年胃肠手术患者的生命体征稳定,可明显改善脑氧代谢及氧化应激反应,并可减少寒颤及烦躁的发生,缩短患者苏醒时间。Objective To investigate the influences of perioperative temperature protection on brain oxygen metabolism and oxidative stress in the elderly patients with gastrointestinal surgery. Methods The clinical case data of 105 cases of elderly patients with gastrointestinal surgery from January 2016 to November 2017 in the Fourth Hospital of Shijiazhuang were retrospectively analyzed, including of routine perioperative treatment as routine group（51 cases） and routine perioperative ＋ heat treatment as study group（54 cases）. The body temperature（Temp）, heart rate（HR） and mean arterial pressure（MAP） were compared before anesthesia（T1）, after 15 mins of operation（T2）, immediately after operation（T3） and 2 h after operation（T4）, as well as the blood oxygen partial pressure（PjvO2）, blood oxygen saturation（SjvO2）, blood oxygen content（CjvO2） and lactate in jugular vein blood（JVL） and serum levels of malondialdehyde（MDA）,superoxide dismutase（SOD） and glutathione peroxidase（GSH-Px）, and the occurrence of chills and irritability and postoperative recovery time were observed. Results The values of Temp, HR and MAP of the study group had no obvious fluctuation（P 〈 0.05）, of which the routine group at T2, T3 and T4 were significantly lower than those at T1（P 〉0.05）, of which the routine group at T3 and T4 were significantly lower than those at T2（P 〈 0.05）. Except T1, the Temp of the study group were significantly higher than those of the routine group（P 〈 0.05）, and the HR and MAP of the study group were significantly lower than those of the routine group（P 〈 0.05）. Except T1, the PjvO2, SjvO2,CjvO2, SOD and GSH-Px of the study group were significantly higher than those of the routine group（P 〈 0.05）, and the JVL and MDA of the study group were significantly lower than those of the routine group（P 〈 0.05）. The incidence rates of chills and irritability of the study group were significantly lower than those of the routine gro

关 键 词：围术期体温保护 胃肠手术 脑氧代谢 氧化应激 

分 类 号：R735[医药卫生—肿瘤]