不同术中PaCO_(2)对老年慢阻肺急性发作患者术后认知功能的影响研究  

Study on the effect of different levels of intraoperative PaCO_(2)on postoperative cognitive function in elderly patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：冯伟 袁圣芝 FENG Wei;YUAN Sheng-zhi(Department of Anesthesia,Zibo Orthopedic Hospital,Zibo 255000,China)

机构地区：[1]淄博市骨科医院麻醉科,255000

出　　处：《中国实用医药》2023年第11期20-23,共4页China Practical Medicine

摘　　要：目的探讨不同术中动脉血二氧化碳分压(PaCO_(2))对老年慢性阻塞性肺疾病(慢阻肺)急性发作患者术后认知功能的影响。方法选择80例实施急诊全身麻醉(全麻)气管插管手术的老年慢阻肺急性发作患者作为研究对象,按照随机数字表法分为观察组和对照组,各40例。对照组术中保持PaCO_(2)于35~44 mm Hg(1 mm Hg=0.133 kPa),观察组术中保持PaCO_(2)于45~55 mm Hg。比较两组麻醉期间脑电双频指数(BIS)值,术后6 h血清生化指标[血清S-100B蛋白、神经元特异性烯醇化酶(NSE)]、认知功能主客观指标[简易智力状态检查量表(MMSE)评分、听觉诱发电位中波幅及潜伏期],术后麻醉苏醒相关指标(呼之睁眼时间、拔管时间及复苏室停留时间),术中知晓及术后认知功能障碍发生情况。结果术前两组患者的BIS值比较差异无统计学意义(P>0.05);麻醉后30 min及手术结束前15 min,观察组患者的BIS值分别为(51.3±1.4)、(58.8±1.0),均显著低于对照组的(56.8±2.6)、(63.3±2.3),差异具有统计学意义(P<0.05)。术后6 h,观察组患者的血清S-100B蛋白(0.4±0.1)ng/ml和NSE(10.8±0.2)ng/ml均明显低于对照组的(1.1±0.3)、(15.1±1.1)ng/ml,差异具有统计学意义(P<0.05)。术后6 h,观察组患者的MMSE评分(28.3±1.1)分高于对照组的(25.7±0.5)分,听觉诱发电位中潜伏期(461.8±33.6)ms长于对照组的(391.5±15.7)ms,听觉诱发电位中波幅(6.8±0.2)μV低于对照组的(9.2±0.6)μV,差异具有统计学意义(P<0.05)。观察组患者的呼之睁眼时间、拔管时间及复苏室停留时间分别为(15.8±2.5)、(18.5±2.9)、(25.4±3.3)min,均短于对照组的(23.9±3.1)、(26.8±3.7)、(38.7±4.7)min,差异具有统计学意义(P<0.05)。观察组患者的术中知晓率0、术后认知功能障碍发生率2.5%均低于对照组的10.0%、17.5%,差异具有统计学意义(P<0.05)。结论针对接受全麻手术的老年慢阻肺急性发作患者,保持术中PaCO_(2)相对高值,能更好的�Objective To discuss the effect of different levels of intraoperative arterial partial pressure of carbon dioxide(PaCO_(2))on postoperative cognitive function in elderly patients with acute exacerbation of chronic obstructive pulmonary disease.Methods A total of 80 elderly patients with acute exacerbation of COPD who underwent emergency general anesthesia for tracheal intubation were selected as the research subjects,and were divided into observation group and control group according to the random numerical table,with 40 cases in each group.The control group maintained PaCO_(2)at 35-44 mm Hg(1 mm Hg=0.133 kPa),and the observation group maintained PaCO_(2)at 45-55 mm Hg.Both groups were compared in terms of bispectral index(BIS),serum biochemical indexes[serum S-100B protein,neuron-specific enolase(NSE)],objective and subjective indexes of cognitive function[mini-mental state examination(MMSE)score,wave amplitude and latency of auditory evoked potentials]at 6 h postoperatively,indexes related to postoperative anesthesia recovery(eye opening time upon calling,extubation time,and duration of stay in resuscitation room),intraoperative awareness,and occurrence of postoperative cognitive dysfunction.Results Before surgery,there was no statistically significant difference in BIS between the two groups(P>0.05).At 30 min after anesthesia and 15 min before the end of surgery,BIS of the observation group were(51.3±1.4)and(58.8±1.0),which were significantly lower than those of(56.8±2.6)and(63.3±2.3)of the control group,and the differences were statistically significant(P<0.05).At 6 h postoperatively,the serum S-100B protein of(0.4±0.1)ng/ml and NSE of(10.8±0.2)ng/ml in the observation group were significantly lower than those of(1.1±0.3)and(15.1±1.1)ng/ml in the control group,and the differences were statistically significant(P<0.05).At 6 h postoperatively,MMSE score of(28.3±1.1)points in the observation group was higher than that of(25.7±0.5)points in the control group;latency of auditory evoked potential of(461.8

关 键 词：动脉血二氧化碳分压 慢性阻塞性肺疾病急性发作 术后认知功能 老年 

分 类 号：R614[医药卫生—麻醉学]