七氟烷-丙泊酚静吸复合全身麻醉下不同二氧化碳气腹压力对行结直肠癌手术老年患者脑氧代谢及应激反应的影响  

Effects of different carbon dioxide pneumoperitoneum pressures combined general anesthesia with sevoflurane-propofol on cerebral oxygenmetabolism balance and stress response in elderly patients undergoing colorectal cancer surgery

作　　者：赵玲玲 张燕[1] 吕良策 罗雅婕 吴洁[2] Zhao Lingling;Zhang Yan;Lyu Liangce;Luo Yajie;Wu Jie(Department of Anesthesiology,Jiading Branch of Shanghai First People′s Hospital(Jiangqiao Hospital,Jiading District),Shanghai 201803,China;Department of Anesthesiology,Shanghai First People′s Hospital,Shanghai 200940,China)

机构地区：[1]上海市第一人民医院嘉定分院(嘉定区江桥医院)麻醉科,上海201803 [2]上海市第一人民医院麻醉科,上海200940

出　　处：《中国医师进修杂志》2023年第6期525-528,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨七氟烷-丙泊酚静吸复合全身麻醉下不同二氧化碳(CO_(2))气腹压力对行结直肠癌手术老年患者脑氧代谢及应激反应的影响。方法回顾性选择2020年2月至2021年2月上海市第一人民医院嘉定分院(嘉定区江桥医院)及上海市第一人民医院收治的100例结直肠癌患者,根据不同CO_(2)气腹压力值划分为压力低组(50例)和压力高组(50例),分别采用12、18 mmHg(1 mmHg=0.133 kPa)CO_(2)压力值进行气腹充气,观察两组患者的围手术期情况、脑氧代谢和应激反应情况。结果压力低组进食时间、首次下床活动时间低于压力高组[(45.67±7.34)h比(49.67±8.16)h、(34.69±8.26)h比(39.87±7.16)h],差异有统计学意义(P<0.05);两组肛门首次排气时间、住院时间比较差异无统计学意义(P>0.05)。重复测量方差分析结果显示,以组别和时点的交互作用为源的主体效应来看,动脉血二氧化碳分压、血氧饱和度、动脉血乳酸、静脉血乳酸随着时点的变化趋势因治疗方式的不同而不同(P<0.05)。压力低组心率、平均动脉压和皮质醇、促甲状腺激素水平均低于压力高组[(73.68±6.35)次/min比(84.84±6.86)次/min、(81.67±13.68)mmHg比(93.68±14.37)mmHg、(100.24±12.34)μg/L比(135.68±13.69)μg/L、(3.12±0.43)mU/L比(3.54±0.34)mU/L],差异有统计学意义(P<0.05)。结论不同CO_(2)气腹压力对行结肠癌手术老年患者的脑氧代谢情况有影响,临床应加以重视。Objective To study the effects of different carbon dioxide(CO_(2))pneumoperitoneum pressures combined general anesthesia with sevoflurane-propofol on cerebral oxygenmetabolism balance and stress response in elderly patients undergoing colorectal cancer surgery.Methods A retrospective collection of 100 colon cancer cases from February 2020 to February 2021 in the Jiading Branch of Shanghai First People′s Hospital(Jiangqiao Hospital,Jiading District)and the Shanghai First People′s Hospital were divided into low pressure group and high pressure group according to different CO_(2) pneumoperitoneum pressure values,each with 50 cases and 12 mmHg(1 mmHg=0.133 kPa)and 18 mmHg CO_(2) pneumoperitoneum pressure values were used to inflate,and the perioperative status,cerebral oxygen metabolism status,and stress response of the two groups were observed.Results The take food time,first time out of bed in the low pressure group were lower than those in the high pressure group:(45.67±7.34)h vs.(49.67±8.16)h,(34.69±8.26)h vs.(39.87±7.16)h,there were statistical differences(P<0.05).The time of first anal exhaust and hospital stay in the two groups had no significant differences(P>0.05).Repeated measures analysis of variance results showed that the levels of partial pressure of carbon dioxide in artery,oxyhemoglobin saturation,arterial blood lactate acid,benous blood lactic acid were different followed the time and treatment methods(P<0.05).The levels of heart rate,mean arterial pressure,cortisol and thyroid stimulating hormone in the low pressure group were higher than those in the high pressure group:(73.68±6.35)beats/min vs.(84.84±6.86)beats/min,(81.67±13.68)mmHg vs.(93.68±14.37)mmHg,(100.24±12.34)μg/L vs.(135.68±13.69)μg/L,(3.12±0.43)mU/L vs.(3.54±0.34)mU/L,there were statistical differences(P<0.05).Conclusions Different CO_(2) pneumoperitoneal pressures affect the brain oxygen metabolism of patients,and clinical attention should be paid to them.

关 键 词：七氟烷 二异丙酚 气腹 人工 结直肠肿瘤 老年人 脑氧代谢 

分 类 号：R614[医药卫生—麻醉学] R735.34[医药卫生—外科学]