不同氧浓度通气对腹腔镜下直肠癌根治术患者氧合及术后认知功能的影响  

Effects of ventilation with different oxygen concentrations on oxygenation and postoperative cognitive function in patients undergoing laparoscopic radical resection of rectal cancer

作　　者：周潇 赵雅梅[1] 丁可 王振红[1] 孙蓓 刘贝 史宏伟[1] ZHOU Xiao;ZHAO Yamei;DING Ke(Depurtment of Anesthesiology,Nanjing First Hospital,Nanjing Medical Universiry,Nanjing 210006,CHINA)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)麻醉科,江苏210006

出　　处：《江苏医药》2023年第3期243-246,共4页Jiangsu Medical Journal

基　　金：南京医科大学科技发展基金项目(NMUB20210198)。

摘　　要：目的观察手术期间吸入不同氧浓度对腹腔镜下直肠癌根治术患者氧合及术后认知功能的影响。方法选取择期行腹腔镜下直肠癌根治术的患者60例随机分为三组,每组20例。机械通气期间,A、B、C组吸入氧浓度(FiO_(2))分别为35%、55%、75%。比较三组患者麻醉诱导前(T1)、插管后5 min(T2)、气腹30 min(T3)、气腹60 min(T4)和关闭气腹10 min(T5)5个时间点的HR、MAP、SpO_(2)和局部脑氧饱和度(rSO_(2)),计算氧合指数(OI)和肺内分流率(Q_(s)/Q_(t))。比较三组手术时间、术后拔管时间、麻醉后监测治疗室(PACU)停留时间。评估术前1 d和术后3 d患者简易精神状态量表(MMSE)评分,比较三组术后认知功能障碍(POCD)发生率。结果三组患者手术时间、术后拔管时间和PACU停留时间差异无统计学意义(P>0.05)。三组T1~T5时的HR、MAP和SpO_(2)比较差异无统计学意义(P>0.05)。A组T3~T5时的rSO_(2)低于B、C组(P<0.05)。A、B组患者T4、T5时的OI小于T1(P<0.05);C组T3~T5时的OI小于T1时(P<0.05)。A、B组患者T3~T5时的Q_(s)/Q_(t)小于C组(P<0.05);A组T5时的Q_(s)/Q_(t)亦小于B组(P<0.05);A、B、C组患者T3~T5时的Q_(s)/Q_(t)大于T1时(P<0.05)。三组患者术前1 d与术后3 d MMSE评分和POCD发生率差异无统计学意义(P>0.05)。结论与55%和75%氧浓度通气相比,35%氧浓度通气可以满足腹腔镜下直肠癌根治术患者手术期间的氧供,对肺内分流影响较小,且对术后认知功能无明显影响。Objective To observe the effects of ventilation with different oxygen concentrationson oxygenation and postoperative cognitive function in the patients undergoing laparoscopic radical resection for rectal cancer.Methods Sixty patients undergoing laparoscopic radical resection for rectal cancer were randomly divided into three groups with 20 cases each.During mechanical ventilation,the inhaled oxygen concentration(FiO_(2))was 35%(group A),55%(group B)or 75%(group C).HR,MAP,SpO_(2) and regional cerebral oxygen saturation(rSO_(2))were monitored and oxygenation index(OI)and intrapulmonary shunt rate(Q_(s)/Q_(t))were calculated at the time points of before anesthesia induction(T1),at 5 min after intubation(T2),at 30 min(T3)and 60 min(T4)during pneumoperitoneum,and at the time after pneumoperitoneumclosing(T5).The operation time,postoperative extubation time,and PACU stay were recorded.Mini-Mental State Examination(MMSE)scores were evaluated in the 1^(st)day before surgery and 3^(rd)day after surgery.The incidence of postoperative cognitive dysfunction(POCD)was compared among the three groups.Results There were no significant differences in operation time,postoperative extubation time and PACU stay among the three groups(P>0.05).There were no significant differences in HR,MAP and SpO_(2) at T1-T5 among the three groups(P>0.05).The rSO_(2) at T3-T5 in group A was lower than that in groups of B and C(P<0.05).The OI at T4 and T5 in groups of A and B was lower than that at T1(P<0.05),which at T3-T5 in group C was lower than that at T1(P<0.05).The Q_(s)/Q_(t) at T3-T5 in groups of A and B was lower than that in group C(P<0.05),which at T5 in group A was lower than that in group B(P<0.05).The Q_(s)/Q_(t) at T3-T5 in groups of A,B and C was higher than that at T1(P<0.05).There were no significant differences in MMSE score 1 day before surgery and 3 days after surgery and in the incidence of POCD among the three groups(P>0.05).ConclusionCompared to the ventilation with 55%or 75%oxygen during the operation,the ventilation with

关 键 词：氧浓度 直肠癌根治术 局部脑氧饱和度 术后认知功能障碍 

分 类 号：R735[医药卫生—肿瘤]