以脑氧饱和度为导向的肺保护性通气策略对老年患者胸腔镜肺癌根治术后谵妄的影响  

Effect of regional cerebral oxygen saturation guided lung protective ventilation on postoperative delirium in elderly

作　　者：滕培兰[1] 徐德荣[1] 吕菲 刘恒花 王宁 冯雪辛[2] TENG Peilan;XU Derong;LYU Fei;LIU Henghua;WANG Ning;FENG Xuexin(Department of Anesthesiology,Ganyu District People’s Hospital,Lianyungang 222100,China)

机构地区：[1]江苏省连云港市赣榆区人民医院麻醉科,222100 [2]首都医科大学宣武医院

出　　处：《临床麻醉学杂志》2020年第10期1009-1012,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨单肺通气(OLV)期间采用脑氧饱和度(rScO 2)为导向的肺保护性通气策略(LPVS)对老年患者胸腔镜下肺癌根治术后谵妄(POD)的影响。方法选取全麻下行胸腔镜下肺癌根治术患者60例,男44例,女16例,年龄65~80岁。采用随机数字表法将随机分为两组:常规肺保护性通气组(PV组)和以rScO 2为导向的肺保护性通气组(TPV组),每组30例。PV组双肺通气(TLV)期间V T 7 ml/kg、肺复张术,OLV期间V T 5 ml/kg、肺复张术。其中肺复张术包括维持吸气压15、20、25 cmH 2O,PEEP 5 cmH 2O,每个压力水平做3次呼吸(5 s/次),每45分钟复张1次。TPV组通气模式同PV组,当rScO 2较基础值降低幅度>10%时,及时采取调控措施,包括:确定电极位置是否准确;调整麻醉深度;调整呼吸参数,适度提高P ET CO 2,使PaCO 2略高于40 mmHg;维持MAP波动幅度小于基础值的20%。计算术中rScO 2最低值(rScO 2min)、rScO 2平均值(rScO 2mean)、rScO 2较基础值下降的最大百分比(rScO 2%max)。术后3 d和5 d采用谵妄评估量表评估POD。结果与PV组比较,TPV组rScO 2min和rScO 2mean明显升高,rScO 2%max明显降低(P<0.05)。术后3 d TPV组POD发生率明显低于PV组(P<0.05),术后5 d两组POD发生率差异无统计学意义。结论老年患者胸腔镜下肺癌根治术中OLV期间维持rScO 2降低幅度低于10%,可明显减少术后早期POD的发生。Objective To evaluate the effect of rScO 2-guidedtunable lung ventilation strategies on postoperative delirium(POD)in elderly patients during one-lung ventilation(OLV).Methods Sixty patients with lung cancer radical resection,44 males and 16 females,aged 65-80 years,were randomly divided into 2 groups(30 cases in each group):protective lung ventilation group(group PV)and tunable lung protectiveventilation group(group TPV).In group PV,V T 7 ml/kg,and lung recruitment maneuver(LRM)was conducted during two-lung ventilation(TLV),V T 5 ml/kg,and LRM was conducted during OLV.The inspiratory pressure of 15,20,25 cmH 2O,PEEP 5 cmH 2O was maintained,3 breaths per pressure(5 s/time),and one LRM took 45 minutes.The ventilation mode in group TPV was the same as that in group PV.When the rScO 2 decreased by more than 10%from the basic value,group TPV took timely control measures to keep the rScO 2 value as normal as possible.The basic rScO 2 value,minimum value(rScO 2min),average value(rScO 2mean),and the maximum percentage of rScO 2 decreasing from the basic value(rScO 2%max)were calculated.The incidence of POD in postoperative 1-5 days was assessed by Confusion Assessment Method(CAM).Results The rScO 2min and rScO 2mean in group TPV were significantly higher in group TPV than those in group PV,whereas the rScO 2%max in group TPV was significantly lower than that in group PV(P<0.05).The incidence of POD in group TPV postoperative 3 days was significantly lower than that in group PV(P<0.05).There was no difference in the incidence of POD between the two groups 5 days after surgery.Conclusion In lung cancer radical surgery for elderly patients,the tunable lung protective ventilation strategy(TPV)has a significant effect on further reducing the decrease of the rScO 2 during OLV,and reducing the incidence of POD.

关 键 词：肺保护性通气策略 单肺通气 脑氧饱和度 术后谵妄 老年 

分 类 号：R614[医药卫生—麻醉学]