局部脑氧饱和度监测目标导向管理在老年脆弱脑功能患者胃肠手术中的应用  

The application of target-oriented management of regional cerebral oxygen saturation monitoring in gastrointestinal surgery of elderly patients with fragile brain function

作　　者：李文娟 王国平 Li Wenjuan;Wang Guoping(Department of Anesthesiology,Changzhi People′s Hospital,Changzhi 046000,China)

机构地区：[1]长治市人民医院麻醉科,长治046000

出　　处：《中国医师进修杂志》2025年第4期331-335,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探究局部脑氧饱和度(rScO_(2))监测目标导向管理在老年脆弱脑功能患者胃肠手术中的应用效果。方法前瞻性选择长治市人民医院2022年1—12月收治的60例行胃肠手术中的老年脆弱脑功能患者为研究对象,按随机数字表法为研究组和常规组,每组30例,研究组术中给予rScO 2监测目标导向管理,常规组术中给予常规麻醉监测管理,比较两组不同时点平均动脉压(MAP)、血气分析及脑氧代谢指标水平,比较两组术后恢复相关指标及术后谵妄(POD)、术后认知功能障碍(POCD)发生率。结果研究组麻醉后30 min MAP水平高于常规组[(90.50±6.03)mmHg比(82.05±6.10)mmHg(1 mmHg=0.133 kPa),差异有统计学意义(P<0.05)。研究组术中60 min、术毕即刻血乳酸(Lac)、血糖(GLU)水平低于常规组[(1.45±0.48)mmol/L比(1.90±0.51)mmol/L、(1.34±0.42)mmol/L比(1.65±0.46)mmol/L、(7.17±0.90)mmol/L比(7.62±0.76)mmol/L、(6.70±0.87)mmol/L比(7.11±0.67)mmol/L],差异有统计学意义(P<0.05)。研究组术后60 min颈静脉血氧含量高于常规组[(98.16±20.34)ml/L比(85.32±18.54)ml/L],脑氧摄取率、颈内静脉-动脉血乳酸差低于常规组[(33.00±7.86)%比(40.52±9.05)%、(0.15±0.05)mmol/L比(0.21±0.07)mmol/L],差异均有统计学意义(P<0.05)。研究组术后苏醒时间、气管拔管时间和住院时间小于常规组[(12.25±2.00)min比(15.00±3.14)min、(14.00±2.34)min比(20.12±4.37)min、(9.00±1.13)d比(9.65±1.25)d],差异有统计学意义(P<0.05)。研究组术后3 d内POD发生率低于常规组[6.67%(2/30)比26.67%(8/30)],差异有统计学意义(χ^(2)=4.32,P<0.05);两组术后1周内POCD发生率比较差异无统计学意义(P>0.05)。结论rScO 2监测目标导向管理能更好地保持老年脆弱脑功能患者血流动力学、脑氧代谢稳定,改善血气分析指标,减少术后认知异常发生,有利于术后转归。ObjectiveTo explore the effect of target-oriented management of regional cerebral oxygen saturation(rScO 2)monitoring on gastrointestinal surgery in elderly patients with fragile brain function.MethodsA total of 60 elderly patients with fragile brain functional surgery admitted to Changzhi People′s Hospital from January 2022 to December 2022 were divided into the study group and the conventional group by the random number table method,each group with 30 cases,rScO 2 monitoring target-oriented management and conventional anesthesia monitoring management were given respectively during the operation.The levels of mean arterial pressure(MAP),blood gas analysis and cerebral oxygen metabolism indexes were compared between the two groups at different time points.Postoperative recovery related indexes and the incidence of postoperative delirium(POD)and postoperative cognitive dysfunction(POCD)were recorded and compared between the two groups.ResultsThe level of MAP at 30 min after anesthesia in the study group was significantly higher than that in the conventional group:(90.50±6.03)mmHg vs.(82.05±6.10)mmHg,1 mmHg=0.133 kPa,there was statistical difference(P<0.05).The levels of blood lactic acid(Lac)and blood glucose(GLU)at 60 min and immediately after surgery in the study group were lower than those in the conventional group:(1.45±0.48)mmol/L vs.(1.90±0.51)mmol/L,(1.34±0.42)mmol/L vs.(1.65±0.46)mmol/L;(7.17±0.90)mmol/L vs.(7.62±0.76)mmol/L,(6.70±0.87)mmol/L vs.(7.11±0.67)mmol/L,there were statistical differences(P<0.05).The jugular veinoxygen content(CjvO 2)at 60 min after operation in the study group was higher than that in the conventional group:(98.16±20.34)ml/L vs.(85.32±18.54)ml/L;cerebral extraction rate of oxygen(CERO 2)and the internal jugular veno-arterial blood lactic acid difference(Djv-aLac)were lower than those in the conventional group:(33.00±7.86)%vs.(40.52±9.05)%,(0.15±0.05)mmol/L vs.(0.21±0.07)mmol/L,there were statistical differences(P<0.05).The recovery time,tracheal extubation time a

关 键 词：老年人 局部脑氧饱和度 脆弱脑功能 胃肠手术 

分 类 号：R614[医药卫生—麻醉学]