低体温保护联合允许性高碳酸血症对沙滩椅体位肩关节镜围手术期脑氧代谢及术后认知功能的影响  

Influences of hypothermia protection combined with permissive hypercapnia on perioperative cerebral oxygen metabolism and postoperative cognitive function during shoulder arthroscopy in beach chair position.

作　　者：王琳 尚文强 沈家亮 WANG Lin;SHANG Wen-qiang;SHEN Jia-liang(Department of Orthopedics,Jizhong Energy North China Medical Fengfeng General Hospital,Handan Hebei 056200,China.)

机构地区：[1]冀中能源华北医疗峰峰总医院骨科,河北邯郸056200

出　　处：《临床和实验医学杂志》2023年第19期2098-2102,共5页Journal of Clinical and Experimental Medicine

基　　金：邯郸市科学技术局项目(编号:19422083046ZC);河北省卫生健康委科研基金项目(编号:20211262)。

摘　　要：目的 探讨低体温保护联合允许性高碳酸血症对沙滩椅体位下肩关节镜围手术期脑氧代谢及术后认知功能的影响。方法 前瞻性选取2018年1月至2020年6月冀中能源华北医疗峰峰总医院收治的193例拟行沙滩椅体位肩关节镜手术的患者,按照随机数字表法分为观察1组(n=49)、观察2组(n=48)、观察3组(n=48)、观察4组(n=48)。观察1组采取正常呼气末二氧化碳分压(PETCO_(2))+常规体温保护,观察2组采取允许性高碳酸血症+常规体温保护,观察3组采取正常PETCO_(2)+低体温保护,观察4组采取允许性高碳酸血症+低体温保护。对比麻醉前(T0)、气管插管后5 min(T_(1))及沙滩椅体位后5 min(T_(2))、10 min(T_(3))、15 min(T_(4))、术毕(T_(5))的脑氧代谢指标(SjvO_(2)、Da-jvO_(2))、血清学指标(Aβ-42、S100β),术前1 d、术后1 d、术后7 d的认知功能[简易智能精神状态检查表(MMSE)],随访不良事件发生情况。结果 4组患者的SjvO_(2)、Da-jvO_(2)比较,差异均有统计学意义(P<0.05);观察2组、观察3组、观察4组T_(2)、T_(3)、T_(4)、T_(5)时刻的SjvO_(2)均高于观察1组,Da-jvO_(2)低于观察1组,差异均有统计学意义(P<0.05)。4组患者的S100β水平比较,差异有统计学意义(P<0.05);观察4组T0、T_(1)、T_(2)、T_(3)、T_(4)、T_(5)时刻的Aβ-42、S100β比较,差异均无统计学意义(P>0.05);与T0、T_(1)时段比较,观察1组、观察2组、观察3组T_(2)、T_(3)、T_(4)、T_(5)时刻的Aβ-42、S100β均较高,差异均有统计学意义(P<0.05)。4组术后1 d的MMSE评分均低于术前1 d,术后7 d均高于术后1 d,差异均有统计学意义(P<0.05);观察2组、观察3组、观察4组术后1 d的MMSE评分高于观察1组,差异均有统计学意义(P<0.05),观察4组术后1 d的MMSE评分高于观察2组、观察3组,差异均有统计学意义(P<0.05)。结论 低体温保护联合允许性高碳酸血症可明显改善沙滩椅体位下肩关节镜手术患者围手术期脑氧代谢及术后认�Objective To investigate the influences of hypothermia protection combined with permissive hypercapnia on perioperative cerebral oxygen metabolism and postoperative cognitive function during shoulder arthroscopy in beach chair position.Methods A total of 193 patients who were admitted to Jizhong Energy North China Medical Fengfeng General Hospital from January 2018 to June 2020 and planned to undergo beach chair shoulder arthroscopy surgery were randomly divided into observation group1(n=49),observation group 2(n=48),observation group 3(n=48),and observation group 4(n=48).Observation group 1 received normal end-expiratory carbon dioxide partial pressure(P ET CO 2)+conventional body temperature protection,observation group 2 received permissive hypercapnia+conventional body temperature protection,observation group 3 received normal P ET CO 2+hypothermia protection,and observation group 4 received permissive hypercapnia+hypothermia protection.Brain oxygen metabolism indicators(SjvO 2,Da jvO 2),serological indicators(Aβ-42,S100β)at pre anesthesia(T 0),5 minutes after tracheal intubation(T_(1)),and 5 minutes after beach chair position(T_(2)),10 minutes(T_(3)),15 minutes(T_(4)),and postoperative(T_(5)),and cognitive function[mini-mental state examination(MMSE)]at 1 day before surgery,1 day after surgery,and 7 days after surgery were compared,and the incidence of adverse events was followed up.Results There were statistically significant differences in SjvO 2 and DajvO 2 among the four groups of patients(P<0.05);the SjvO 2 levels at T_(2),T_(3),T_(4),and T_(5) in observation group 2,observation group 3,and observation group 4 were higher than those in observation group 1,while DajvO 2 levels were lower than those in observation group 1,the differences were statistically significant(P<0.05).There was a statistically significant difference in S100βlevels among the four groups of patients(P<0.05);there was no statistically significant difference in the comparison of Aβ-42,S100βat T 0,T_(1),T_(2),T_(3),T_(4),and T_(5)

关 键 词：低体温保护 允许性高碳酸血症 沙滩椅体位 肩关节镜 脑氧代谢 认知功能 不良事件 

分 类 号：R614[医药卫生—麻醉学]