允许性高碳酸对肺叶切除术老年患者炎症刺激和认知功能的影响  

Effects of permissive hypercapnia on inflammatory stress and cognitive function inelderly patients undergoing pulmonary lobectomy

作　　者：崔芝红 姚娜娜 朱贤林 CUI Zhihong;YAO Nana;ZHU Xianlin(Department of Western Medicine Anesthesia,the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture,Enshi 445000,Hubei,China)

机构地区：[1]恩施土家族苗族自治州中心医院西医部麻醉科,湖北恩施445000

出　　处：《中南医学科学杂志》2023年第6期886-889,共4页Medical Science Journal of Central South China

基　　金：湖北省自然科学基金项目(2016CFB368)。

摘　　要：目的允许性高碳酸(PHC)对肺叶切除术老年患者炎症刺激和认知功能的影响。方法选择肺叶切除术老年患者120例,随机均分为允许性高碳酸组[PHC组,二氧化碳分压(PCO_(2))45~55 mmHg]和对照组(PCO_(2)35~45 mmHg)。记录手术期间平均动脉压、心率。ELISA检测术前、手术5 min、手术结束及术后24 h两组血肾上腺素、皮质醇及肿瘤坏死因子-α(TNF-α)水平。比较两组术前和术后7天简易精神状态检查量表(MMSE)评分和术后7天认知障碍(POCD)发生率。结果两组手术期间心率、平均动脉压比较差异无显著性(P>0.05)。与术前比较,两组术后7天MMSE评分均下降,但PHC组术后第7天MMSE评分高于对照组;术后7天POCD发生率PHC组低于对照组(P<0.05)。术后24 h PHC组皮质醇、肾上腺素、TNF-α水平,以及手术结束时肾上腺素水平均低于同时间对照组(P<0.05)。结论PHC可有效预防老年肺叶切除术后认知功能障碍,可能与PHC降低手术引起的应激反应和炎症反应有关。Aim To explore the effects of permissive hypercapnia(PHC)on inflammatory stress and cognitive function in elderly patients undergoing pulmonary lobectomy.Methods One hundred and twenty elderly patients undergoing lobectomy were selected,and randomly assigned into PHC group[partial pressure of carbon dioxide(PCO_(2))ranging from 45 to 55 mmHg]and control group(PCO_(2)ranging from 35 to 45 mmHg),each with 60 cases.The mean arterial blood pressure and heart rate were recorded during surgery.Serum concentrations of adrenaline,cortisol and tumor necrosis factorα(TNF-α)were measured by using ELISH at the baseline,5 minutes after anaesthesia induction,end of surgery and 24 h after surgery.The mini-mental state examination(MMSE)score at baseline and 7 days after surgery,as well as the incidence rate of postoperative cognitive dysfunction(POCD)at postoperative 7 days,were compared between two groups.Results No statistical difference was observed between two groups in mean arterial blood pressure and heart rate during operation(P>0.05).A reduction in MMSE score was observed in both groups,and PHC group scored higher on MMSE than control group at 7-daypost-operation.The incidence rate of POCD at 7-day post operation was lower in PHC group than in control group(P<0.05).Serum concentrations of adrenaline,cortisol and TNF-αat 24h post-operation as well as cortisol concentration at the end of surgery were all lower in PHC group than in control group(P<0.05).Conclusion PHC can effectively prevent cognitive dysfunction after pulmonary lobectomy in the elderly,which may be related with the alleviation in stress and inflammatoryresponse.

关 键 词：允许性高碳酸血症 肺叶切除术 老年 POCD 应激反应 炎症反应 

分 类 号：R563[医药卫生—呼吸系统]