肺开放策略对腹腔镜手术老年患者术后谵妄的影响  

Effects of open-lung strategy on postoperative delirium in elderly patients undergoing laparoscopic surgery

作　　者：朱祥鹏 罗超 黄天丰 张扬 高巨 Zhu Xiangpeng;Luo Chao;Huang Tianfeng;Zhang Yang;Gao Ju(Department of Anesthesiology,Northern Jiangsu People′s Hospital Affiliated to Yangzhou University,Yangzhou 225001,China)

机构地区：[1]扬州大学附属苏北人民医院麻醉科,扬州225001

出　　处：《中华麻醉学杂志》2023年第2期137-141,共5页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(82172190);江苏省卫生健康委员会医学科研项目面上项目(2021-166号);扬州市重点实验室培育专项基金(YZ20211148)。

摘　　要：目的评价肺开放策略(OLS)对腹腔镜手术老年患者术后谵妄(POD)的影响。方法选取择期全麻下行腹腔镜直肠癌根治术或前列腺癌根治术老年患者74例,性别不限,年龄65~80岁,BMI 18.5~30.0 kg/m^(2),ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=37):OLS组和非OLS组(NOLS组)。OLS组术中给予小潮气量通气、肺复张和个体化呼气末正压,NOLS组患者给予5 cmH_(2)O的固定呼气末正压。于麻醉诱导前(T_(0))、气管插管后10 min(T_(1))、气腹后1 h(T_(2))、2 h(T_(3))和气管拔管后10 min(T_(4))时记录脑氧饱和度(rSO_(2))、pH值、PaO_(2)、PaCO_(2)和PaO_(2)/FiO_(2)。于术前、术毕和术后1 d时采用ELISA法测定血清IL-6、IL-10和钙结合蛋白(S100β)浓度。术后1~3 d采用谵妄评估量表评估POD的发生情况。结果与NOLS组比较,OLS组T_(3)时pH值降低,PaCO_(2)升高,T_(2)~T_(4)时PaO_(2)、PaO_(2)/FiO_(2)和rSO_(2)升高,术毕和术后1 d时血清IL-6和S100β浓度降低,血清IL-10浓度升高,POD发生率降低(P<0.05)。结论OLS可提高rSO_(2),减轻全身炎症反应,降低腹腔镜手术老年患者POD的发生风险。Objective To evaluate the effect of open-lung strategy(OLS)on postoperative delirium(POD)in elderly patients undergoing laparoscopic surgery.Methods Seventy-four elderly patients of both sexes,aged 65-80 yr,with body mass index of 18.5-30.0 kg/m^(2),of American Society of Anesthesiologists Physical Status classificationⅡorⅢ,undergoing elective laparoscopic radical rectal cancer or radical prostate cancer surgery under general anesthesia,were divided into 2 groups(n=37 each)by the random number table method:OLS group and non-OLS(NOLS)group.Patients in OLS group received small tidal volume ventilation,recruitment maneuvers,and individualized positive end-expiratory pressure.Fixed positive end-expiratory pressure 5 cmH_(2)O was given in NOLS group.Cerebral regional oxygen saturation(rSO_(2)),pH value,PaO_(2),PaCO_(2) and PaO_(2)/FiO_(2) were recorded before induction of anesthesia(T_(0),baseline value),at 10 min after tracheal intubation(T_(1)),at 1 and 2 h after pneumoperitoneum(T_(2),3)and at 10 min after extubation(T_(4)).The levels of serum interleukin-6(IL-6),IL-10 and calcium-binding protein(S100β)were measured by enzyme-linked immunosorbent assay before surgery,at the end of surgery,and at 1 day after surgery.The development of POD was assessed using the delirium assessment scale at 1-3 days after surgery.Results Compared with NOLS group,the pH value was significantly decreased at T_(3),PaCO_(2) was increased,PaO_(2),PaO_(2)/FiO_(2) and rSO_(2) were increased at T_(2)-4,serum IL-6 and S100βconcentrations were decreased after surgery and at 1 day after surgery,the serum IL-10 concentration was increased,and the incidence of POD was decreased in OLS group(P<0.05).Conclusions OLS can increase rSO_(2),reduce the systemic inflammatory response,and decrease the risk of POD in elderly patients undergoing laparoscopic surgery.

关 键 词：呼吸 人工 老年人 腹腔镜检查 谵妄 手术后并发症 

分 类 号：R614[医药卫生—麻醉学]