不同水平呼气末正压对老年腹腔镜下结直肠癌根治术患者脑氧供需平衡、炎症因子和脑损伤标志物的影响  

Effects of Different Levels of Positive End Expiratory Pressure on Brain Oxygen Supply-demand Balance,Inflammatory Factors and Brain Injury Markers in Elderly Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer

作　　者：白香花 耿强 段伟琴 何金玲 赵智慧 BAI Xiang-hua;GENG Qiang;DUAN Wei-qin;HE Jin-ling;ZHAO Zhi-hui(Department of Anesthesiology,People's Hospital of Inner Mongolia,Hohhot,Inner Mongolia,010017,China;Department of Anesthesiology,Inner Mongolia Armed Police Corps Hospital,Hohhot,Inner Mongolia,010041,China)

机构地区：[1]内蒙古自治区人民医院麻醉科,内蒙古呼和浩特010017 [2]武警内蒙古总队医院麻醉科,内蒙古呼和浩特010041

出　　处：《现代生物医学进展》2023年第21期4142-4146,共5页Progress in Modern Biomedicine

基　　金：内蒙古自治区自然科学基金项目(2019MS08091);内蒙古自治区人民医院院内基金项目(2020YN03)。

摘　　要：目的:探讨不同水平呼气末正压(PEEP)对老年腹腔镜下结直肠癌根治术患者脑氧供需平衡、炎症因子和脑损伤标志物的影响。方法:选择我院2019年12月-2020年12月收治的90例行腹腔镜下结直肠癌根治术患者,根据随机数字表法分为A组(n=30)、B组(n=30)、C组(n=30),每组均为压力控制容量保证(PCV-VG)模式联合小潮气量加滴定PEEP;其中C组的PEEP值为肺动态顺应性(Cdyn)滴定法下最适PEEP,B组的PEEP=5 cm H2O,A组的PEEP=0 cm H_(2)O。对比三组脑氧供需平衡、炎症因子和脑损伤标志物,同时记录三组治疗期间不良反应发生率。结果:气腹后15 min(T1)、停气腹平卧位15 min(T2)时间点,B组、C组颈内静脉血氧饱和度(Sjv O_(2))、动脉-颈内静脉血氧含量差(AVDO_(2))、局部脑组织氧饱和度(r ScO_(2))高于A组,且C组高于B组同时间点(P<0.05)。术后1 d,B组、C组血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平低于A组,且C组低于B组同时间点(P<0.05)。术后1 d,B组、C组血清神经元特异性烯醇化酶(NSE)、S100β低于A组,但C组低于B组同时间点,而脑源性神经营养因子(BDNF)水平高于A组,且C组高于B组同时间点(P<0.05)。三组不良反应发生率组间对比无统计学差异(P>0.05)。结论:Cdyn滴定法下最适PEEP可维持老年腹腔镜下结直肠癌根治术患者脑氧供需平衡,减轻炎症因子分泌,降低脑损伤标志物水平,安全性较好。Objective:To explore the effects of different levels of positive end expiratory pressure(PEEP)on brain oxygen sup-ply-demand balance,inflammatory factors and brain injury markers in elderly patients undergoing laparoscopic radical resection of col-orectal cancer.Methods:90 patients who underwent laparoscopic radical resection of colorectal cancer who were admitted to our hospital from December 2019 to December 2020 were selected,and they were divided into group A(n=30),group B(n=30),and group C(n=30)according to the random number table method.Each group adopts the pressure control capacity guarantee(PCV-VG)mode combined with small tidal volume plus titration PEEP.The PEEP value of group C was the optimal PEEP under the lung dynamic compliance(Cdyn)titration method,the PEEP of group B equal to 5 cm H_(2)O,while the PEEP of group A equal to 0 cm H_(2)O.The brain oxygen sup-ply-demand balance,inflammatory factors and brain injury markers were compared between three groups,and the incidence of adverse reactions during the treatment period were simultaneously recorded between three groups.Results:At the time points of 15 min after pneumoperitoneum(T1)and 15 min after stopping pneumoperitoneum in a supine position(T2),the jugular venous oxygen saturation(SjvO_(2)),arterio-venous oxygen content diference(AVDO_(2)),and regional cerebral oxygen saturation(rScO_(2))of group B and group C were higher than those of group A,and group C were higher than those of group B at the same time point(P<0.05).1 d after surgery,the levels of serum interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)of group B and group C were lower than group A,and group C were lower than those of group B at the same time point(P<0.05).1 d after surgery,the serum neuron specific enolase(NSE),S100βof group B and group C were lower than those of group A,but group C were lower than those of group B at the same time point,while the level of brain-derived neurotrophic factor(BDNF)was higher than that of group A,and that of group C was higher than that of

关 键 词：呼气末正压 老年 腹腔镜 结直肠癌根治术 脑氧供需平衡 炎症因子 脑损伤标志物 

分 类 号：R735.3[医药卫生—肿瘤]