肺保护性通气对老年脆弱脑功能患者术后神经认知恢复延迟的影响  

Effect of lung protective ventilation on postoperative neurocognitive recovery delay in elderly patients with fragile brain

作　　者：陈小萍[1] 全逸峰 CHEN Xiaoping;QUAN Yifeng(Department of Anesthesiology,Northern Jiangsu People’s Hospital,Yangzhou 225001,CHINA)

机构地区：[1]苏北人民医院麻醉科,江苏扬州225001 [2]苏北人民医院康复医学科,江苏扬州225001

出　　处：《江苏医药》2021年第6期619-622,共4页Jiangsu Medical Journal

摘　　要：目的观察肺保护性通气对老年脆弱脑功能患者术后神经认知恢复延迟的影响。方法择期全身麻醉下拟行胃肠手术的脆弱脑功能患者120例随机分为两组,分别采用保护性通气(PV组,60例)和常规通气(CV组,60例)。PV组给予呼吸末正压10 cmH_2O,每间隔45 min行双肺肺复张1次,维持P_(ET)CO_(2)在35~40 mmHg。分别于术前1 d (T0)、术后6 h (T1)、12 h (T2)、24 h (T3)及48 h (T4)时采集颈静脉球部静脉血样,应用ELISA法检测血清星形胶质细胞S100蛋白的β亚型(S-100β)及神经元特异性烯醇化酶(NSE)的浓度。于T0、T3、T4、术后72 h(T5)、7 d(T6)及1个月(T7)时应用蒙特利尔认知评估量表(MoCA量表)北京版评估认知功能。结果 T0时,两组患者血清NSE、S-100β浓度和MoCA评分比较差异无统计意义(P>0.05)。T1、T2、T3时,两组血清NSE和S-100β浓度较均T0时升高(P<0.05),且PV组血清NSE和S-100β浓度低于CV组(P<0.05),而T4时两组上述指标比较差异无统计学意义(P>0.05)。与T0时比较,CV组T3、T4时MoCA评分降低,而PV组仅T3时MoCA评分降低(P<0.05)。PV组T4、T5时MoCA评分高于CV组(P<0.05);T3、T6、T7时两组间MoCA评分比较差异无统计学意义(P>0.05)。结论肺保护性通气策略可在一定程度上改善老年脆弱脑功能全身麻醉胃肠手术患者术后早期的神经认知功能,减少其术后早期神经认知恢复延迟的发生。Objective To observe the effect of lung protective ventilation on the postoperative neurocognitive recovery delay in elderly patients with fragile brain.Methods One hundred and twenty patients with fragile brain scheduled for selective gastrointestinal surgery under general anesthesia were randomly divided into two groups,who were ventilated with lung protective ventilation(group A,60 cases)or conventional ventilation(group C,60 cases).The lung protective ventilation was performed with a PEEP of 10 cmH2O and lung recruitment maneuver every 45 minutes to keep a PETCO_(2) of 35-40 mmHg.Blood samples from the jugular bulb were collected one day before operation(T0)and 6 hours(T1),12 hours(T2),24 hours(T3)and 48 hours(T4)after operation.Serum concentrations of astrocyte S100 proteinβsubtype(S-100β)and neuron-specific enolase(NSE)were detected by ELISA.The Montreal cognitive assessment scale(MoCA scale,Beijing version)was used to assess the cognitive function at T0,T3,T4,72 hours(T5),7 days(T6),and one month(T7)after surgery.Results At T0,there were no significant differences in serum concentrations of NSE and S-100βand MoCA score between two groups(P>0.05).At T1,T2,and T3,serum NSE and S-100βconcentrations in two groups were higher than those at T0(P<0.05),which were lower in group A than those in group C(P<0.05).There were no significant differences in the above indicators between two groups at T4(P>0.05).Compared with T0,the MoCA score of group C was decreased at T3 and T4,which in group A was decreased only at T3(P<0.05).The MoCA scores at T4 and T5 in group A were higher than those in group C(P<0.05),which were not significantly different between two groups at T3,T6 and T7(P>0.05).Conclusion Lung protection ventilation strategy can improve the early postoperative neurocognitive function and reduce the incidence of delayed neurocognitive recovery in elderly patients with fragile brain undergoing gastrointestinal surgery under general anesthesia.

关 键 词：肺保护性通气策略 脆弱脑功能 神经认知恢复延迟 

分 类 号：R614[医药卫生—麻醉学]