老年患者术中不同呼气末二氧化碳分压对局部脑氧饱和度和术后早期认知功能的影响  

Effect of end-tidal carbon dioxide levels on cerebral regional oxygen saturation and early postoperative cognitive function in elderly patients

作　　者：颜燕琳 陈晓辉[1] 龚灿生[1] 郑晓春[1] Yan Yanlin;Chen Xiaohui;Gong Cansheng;Zheng Xiaochun(Department of Anesthesiology,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院麻醉科,福州350001

出　　处：《创伤与急诊电子杂志》2022年第3期137-143,162,共8页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的研究术中不同的呼气末二氧化碳分压(partial pressure of end-tidal carbon dioxide,PetCO_(2))对腹腔镜上腹部手术老年患者局部脑氧饱和度和术后认知功能障碍(postoperative cognitive dysfunction,POCD)的影响。方法选择90例2019—2020年福建省立医院行腹腔镜上腹部手术患者,按随机数表法将患者分成3组,最终纳入84例进行数据分析,每组28例,A组:术中PetCO_(2)维持在36~40mmHg;B组:PetCO_(2)维持在41~45mmHg;C组:PetCO_(2)维持在46~50mmHg。于入手术室即刻(T_(0))、麻醉插管后5min(T_(1))、手术开始时(T_(2))、手术开始后1h(T_(3))、手术开始后2h(T_(4))、手术结束即刻(T_(5))、拔管后5min(T_(6))记录双侧局部脑氧饱和度(regional cerebral oxygen saturation,rScO_(2))和血流动力学参数;且分别于术前1d(D_(0))、术后1h(D_(1))、术后第1天(D_(2))及术后第7天(D_(3))利用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)进行评分,采集患者静脉血,测定血清β淀粉样蛋白42(amyloid protein 42,Aβ-42)、磷酸化tau蛋白(phosphorylated tau protein,p-tau)水平,记录术中低脑氧饱和度事件和术后7d内并发症等。结果术后第1天共有36例患者(42.86%)发生POCD,但3组患者之间的发生率差异无统计学意义;其中18例在术后7d内恢复,术后第7天仍有18例(21.43%)患者存在POCD,3组患者之间的发生率仍差异无统计学意义。3组患者T_(1)~T_(6) rScO_(2)均较T_(0)时升高(P<0.05)。在T_(3)~T_(5)时段,C组的rScO_(2)均较A组显著升高(P<0.05),但与B组差异无统计学意义(P>0.05)。在D_(2)、D_(3),C组Aβ-42水平显著低于B组(P<0.05),B组Aβ-42显著低于A组(P<0.05)。术后各时点,C组的p-tau水平均显著低于A组(P<0.05),在D_(2)、D_(3),C组的p-tau水平较B组显著降低(P<0.05)。术中低rScO_(2)事件发生率C组显著低于A组(P<0.001),但C组术后肺部感染的发生率显著高于A组(P<0.001)。3组患者同一时间点的平均动脉压均差异无统计学意义(P>0.Objective To investigate the effect of different end-tidal carbon dioxide levels on cerebral regional oxygen saturation(rScO_(2))and early postoperative cognitive dysfunction(POCD)in elderly patients undergoing laparoscopic upper abdominal surgery.Method Ninety patients were randomly divided into three groups.Eighty-four patients(age:60-80 years)scheduled to undergo radical laparoscopic gastrectomy were included in the final analysis.The indicated PetCO_(2) was maintained for patients in each group(group A:PetCO_(2),36-40 mmHg;group B:PetCO_(2),41-45 mmHg,and group C:PetCO_(2),46-50 mmHg).The intraoperative rScO_(2) was recorded at timepoints ranging from arrival at the operating room to post-extubation(T_(0)-T_(6)).The Montreal Cognitive Assessment(MoCA)was conducted at 1 d before surgery(D_(0)),1 h(D_(1)),1 d(D_(2))and 7 d(D_(3))after surgery.The changes in serum concentrations of amyloid protein 42(Aβ-42)and phosphorylated tau protein(p-tau)were measured at 1d before surgery(D_(0)),1 h(D_(1))and 1 d(D_(2))and 7 d(D_(3))after surgery.Result A total of 36 patients(42.86%)developed POCD 1 d after surgery,but there was no significant difference in the incidence among the three groups(P>0.05).Among them,18 patients recovered within 7 days after surgery,and 18 patients(21.43%)still had POCD 7 days after surgery,and there was no significant difference in the incidence among the three groups(P>0.05).The rScO_(2) at T_(1)(5 min after intubation)-T_(6)(5 min after extubation)were significantly higher than those at T_(0)(arrival at the operating room)(P<0.05).rScO_(2) in group C was significantly higher than that in group A between T_(3)(1h after skin incision)and T_(5)(the end of the operation)(P<0.05).At D_(2) and D_(3),Aβ-42 level in group C was significantly lower than that in group B(P<0.05),and Aβ-42 level in group B was significantly lower than that in group A(P<0.05).After surgery,the p-tau level in group C was significantly lower than that in group A(P<0.05);at D_(2) and D_(3),the p-tau level in group C was s

关 键 词：呼气末二氧化碳分压 术后认知功能障碍 局部脑氧饱和度 老年患者 

分 类 号：R614[医药卫生—麻醉学]