老年腹腔镜胃肠手术患者脑氧代谢与术后谵妄的关系  

RELATIONSHIP BETWEEN CEREBRAL OXYGEN METABOLISM AND POSTOPERATIVE DELIRIUM IN ELDERLY PATIENTS UNDERGOING LAPAROSCOPIC GASTROINTESTINAL SURGERY

作　　者：张晓 毕燕琳[2] 王玲[2] 王彬[2] 王明山[2] ZHANG Xiao;BI Yanlin;WANG Ling;WANG Bin;WANG Mingshan(Department of Anesthesiology, Weifang Medical University, Weifang 261000, China)

机构地区：[1]潍坊医学院麻醉学系,山东潍坊261000 [2]青岛市市立医院东院麻醉手术科

出　　处：《精准医学杂志》2019年第2期152-154,158,共4页Journal of Precision Medicine

基　　金：青岛市市南区科技局立项课题(2014-14-032-YY)

摘　　要：目的探讨老年腹腔镜胃肠手术患者脑氧代谢与术后谵妄(POD)的关系。方法选择择期行腹腔镜胃肠手术患者155例,自入手术室开始持续监测脑血氧饱和度(rScO_2)并计算rScO_2曲线下面积(AUC-rScO_2),病人进行血气分析,并计算脑摄氧率(CMRO_2)。术后3d内每日以ICU精神错乱评估量表(CAM-ICU)判断患者是否发生谵妄。结果 155患者中有16例患者发生过谵妄,谵妄发生率为10.32%。谵妄组患者术中rScO_2基础值、rScO_2最高值、rScO_2最低值及AUC-rScO_2均有低于非谵妄组患者的趋势,但差异并无统计学意义(P>0.05)。谵妄组患者气腹前、气腹结束即刻动脉CO_2分压、葡萄糖浓度、血红蛋白水平、血细胞比容、乳酸水平与非谵妄组患者比较差异无统计学意义(P>0.05),但谵妄组各指标的变化幅度明显高于非谵妄组(t=2.016～5.833,P<0.05)。谵妄组患者气腹前、气腹结束即刻CMRO_2与非谵妄组患者比较差异无统计学意义(P>0.05),但谵妄组患者在气腹后的CMRO_2的下降幅度明显高于非谵妄组(t=1.985,P<0.05)。结论老年腹腔镜胃肠手术患者谵妄的发生与术中rScO_2下降幅度和持续时间无关,与术中CMRO_2下降有关。Objective To investigate the relationship between cerebral oxygen metabolism and postoperative delirium in elderly patients undergoing laparoscopic gastrointestinal surgery. Methods A total of 155 patients undergoing elective laparoscopic gastrointestinal surgery were enrolled. The regional cerebral oxygen saturation was continuously monitored from the time the patient entering the operating room, and the area under rScO 2 curve (AUC-rScO 2) was calculated. Blood gas analysis was performed, and cerebral metabolic rate of oxygen (CMRO 2) was calculated. The Confusion Assessment Method for the ICU (CAM-ICU) was used daily to determine whether the patient developed delirium within 3 days after the surgery. Results Of the 155 patients,16 developed delirium, resulting an incidence of 10.32 %. During the surgery, the baseline rScO 2, highest rScO 2, lowest rScO 2, and AUC-rScO 2 were lower in the delirium group than in the non-delirium group, but the differences were not statistically significant ( P >0.05). There were no significant differences in arterial CO 2 partial pressure, glucose concentration, hemoglobin level, hematocrit, and lactate level before and immediately after pneumoperitoneum in the delirium group and the non-delirium group ( P >0.05), but the delirium group had significantly greater changes in these parameters than the non-delirium group ( t = 2.016 -5.833, P <0.05). There was no significant difference in CMRO 2 before and immediately after pneumoperitoneum between the delirium group and the non-delirium group ( P >0.05), but the decrease in CMRO 2 after pneumoperitoneum in delirium group was significantly higher than that in the non-delirium group ( t =1.985, P <0.05). Conclusion The development of postoperative delirium in elderly patients undergoing laparoscopic gastrointestinal surgery is not associated with the degree and duration of intraoperative rScO 2 decline, but is associated with the decrease in CMRO 2 during operation.

关 键 词：消化系统外科手术 腹腔镜检查 谵妄 脑 氧 代谢 血气分析 血氧测定法 

分 类 号：R656[医药卫生—外科学] R741.041[医药卫生—临床医学]