允许性高碳酸血症联合目标导向液体治疗对妇科腹腔镜手术患者脑氧代谢和术后认知功能的影响  

Effect of Permissive Hypercapnia Combined with Goal-directed Fluid Therapy on Cerebral Oxygen Metabolism and Postoperative Cognitive Function in Patients Undergoing Gynecological Laparoscopic Surgery

作　　者：孙诗媛 张志强[1] 边庆虎[1] 高礼[1] 孟利江 张山[1] SUN Shi-yuan;ZHANG Zhi-qiang;BIAN Qing-hu;GAO Li;MENG Li-jiang;ZHANG Shan(Department of Anesthesiology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei,China)

机构地区：[1]河北医科大学第二医院麻醉科,河北石家庄050000

出　　处：《医学信息》2023年第24期46-50,共5页Journal of Medical Information

摘　　要：目的探究允许性高碳酸血症(PHC)联合目标导向液体治疗(GDFT)对妇科腹腔镜手术患者脑氧代谢和术后认知功能的影响。方法选取2021年1月-12月于河北医科大学第二医院东院区择期行妇科肿瘤腹腔镜手术患者60例,采用随机数字表法分为PHC组(P组)和常规通气组(C组)。两组均应用GDFT进行补液。P组:潮气量6~8 ml/kg,I∶E=1∶2,维持PaCO_(2)为46~55 mmHg,pH 7.25~7.35;C组:潮气量10~12 ml/kg,I∶E=1∶2,维持PaCO_(2)为35~45 mmHg,pH 7.35~7.45。记录并比较两组输液量、出血量、尿量、气腹时间、T体位时间、手术时间;记录两组入室后(T_(0)),气管插管后5 min(T_(1)),T体位30 min(T_(2)),T体位60 min(T_(3)),T体位90 min(T_(4)),术毕(T_(5))的HR、MAP、rSO_(2)、EtCO_(2)、PaCO_(2)、pH;记录并计算两组时刻桡动脉血和颈静脉球部血氧饱和度(SjvO_(2))、动静脉血氧含量差(Da-jvO_(2))、脑氧摄取率(CERO_(2))、动静脉乳酸含量差(Da-jvLac);记录两组神经损伤标志物NSE、S100β蛋白浓度以及术前1天(M0)、术后1天(M1)、术后3天(M2)MMSE评分。结果两组HR、MAP、输液量、失血量、尿量、气腹时间、T体位时间、手术时间、Da-jvLac比较,差异均无统计学意义(P>0.05);P组T_(2)~T_(4)时刻rSO_(2)、EtCO_(2)、PaCO_(2)和SjvO_(2)高于C组,而pH、CERO_(2)和Da-jvO_(2)以及S100β和NSE低于C组,差异有统计学意义(P<0.05);P组M1时刻MMSE评分高于C组,差异有统计学意义(P<0.05)。结论允许性高碳酸血症联合目标导向液体治疗应用于妇科腹腔镜手术患者可优化围术期液体管理,改善脑氧代谢和术后认知功能。Objective To investigate the effects of permissive hypercapnia(PHC)combined with goal-directed fluid therapy(GDFT)on cerebral oxygen metabolism and postoperative cognitive function in gynecological patients undergoing laparoscopic surgery.Methods From January to December 2021,60 patients undergoing laparoscopic surgery for gynecological tumors in the Eastern Hospital of the Second Hospital of Hebei Medical University were selected and divided into PHC group(group P)and conventional ventilation group(group C)by random number table method.Both groups were treated with GDFT for rehydration.Group P:tidal volume 6-8ml/kg,I∶E=1∶2,PaCO_(2)46-55mmHg,pH 7.25-7.35;group C:tidal volume 10-12ml/kg,I∶E=1∶2,PaCO_(2)35-45mmHg,pH 7.35-7.45.The infusion volume,bleeding volume,urine volume,pneumoperitoneum time,T position time,and operation time were recorded betwwen the two groups.HR,MAP,rSO_(2),EtCO_(2),PaCO_(2)and pH were recorded at the time of entering operation room(T_(0)),5 min after tracheal intubation(T_(1)),30 min after T position(T_(2)),60 min after T position(T_(3)),90 min after T position(T_(4))and the end of operation(T_(5)).Thejugular bulb blood oxygen saturation(SjvO_(2)),arteriovenous blood oxygen content difference(Da-jvO_(2)),cerebral oxygen uptake rate(CERO_(2))anddifference of arterial and venous lactic acid content(Da-jvLac)was recorded or calculated.The nerve injury markers such as NSE and S100βprotein concentration was measured.and the MMSE score on preoperative 1d(M0),postoperative 1d(M1)and 3 d(M2)was observed.Results There were no statistically significant differences in HR,MAP,infusion volume,bleeding volume,urine volume,pneumoperitoneum time,T position time,operation time,Da-jvLac between the two groups(P>0.05).At T_(2)-T_(4),rSO_(2),EtCO_(2),PaCO_(2)and SjvO_(2)in group P were higher than those in group C,while pH,CERO_(2)and Da-jvO_(2),S100βand NSE were lower than those in group C(P<0.05).The MMSE score of group P at M1 was higher than that of group C,and the difference was statistically si

关 键 词：允许性高碳酸血症 目标导向液体治疗 腹腔镜手术 脑氧代谢 认知功能 

分 类 号：R614[医药卫生—麻醉学]