允许性高碳酸血症通气策略对老年腹腔镜手术患者脑氧代谢、认知功能及肺功能参数的影响
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摘要
目的探讨允许性高碳酸血症通气策略(PHY)对老年腹腔镜手术患者脑氧代谢、认知功能及肺功能参数的影响。方法 2015年9月至2017年9月间接受腹腔镜手术治疗的慢性胆囊炎患者110例,回顾麻醉过程中所用通气策略并将入组患者分为接受常规通气策略的对照组57例、接受PHY的研究组53例。对比分析两组患者的气腹前即刻、气腹后1 h的脑氧代谢,术前24 h、术后24 h的认知功能及气腹前、气腹后10 min、放气后10 min肺功能情况。结果气腹后1 h,研究组患者的颈内静脉血氧饱和度(SjvO_2)水平高于对照组,脑动静脉血氧含量差值(CaO_2-CjvO_2)、脑氧摄取率(CERO_2)水平低于对照组患者(P<0.05);术后24 h,研究组患者血清中脑源性神经营养因子(BDNF)的含量高于对照组患者,神经元特异性烯醇化酶(NSE)、β淀粉样蛋白(Aβ)、同型半胱氨酸(Hcy)的含量低于对照组患者(P<0.05);气腹后10 min、放气后10 min,研究组患者的气道峰压(Ppeak)水平低于对照组患者,静态胸肺顺应性(Cst)、动态胸肺顺应性(Cdyn)水平高于对照组患者(P<0.05)。结论老年腹腔镜手术患者术中采用PHY,可有效优化患者脑氧代谢水平并改善术后认知功能,减少术中肺功能损伤。
Objective To study the effect of permissive hypercapnia ventilation strategy on brain oxygen metabolism,cognitive function and pulmonary function parameters in elderly patients underwent laparoscopic surgery. Methods 110 cases of chronic cholecystitis patients underwent laparoscopic surgery in our hospital from September 2015 to September 2017 were chosen as research objects,ventilation strategies during anesthesia period were reviewed and all patients were divided into control group( n = 57,underwent conventional ventilation strategy),study group( n = 53,underwent permissive hypercapnia ventilation strategy). The differences of brain oxygen metabolism,cognitive function and lung function were compared between two groups. Results 1 h after pneumoperitoneum,SjvO_2 levels in study group was higher than that in control group,CaO_2-CjvO_2,CERO_2 levels were lower than that in control group( P < 0. 05). 24 h after surgery,serum content of BDNF in study group washigher than that in control group,NSE,Aβ,Hcy in study group were lower than those in control group( P < 0. 05). 10 min after pneumoperitoneum and 10 min after release. P peak level in study group was lower than that in control group,Cst,Cdyn levels were higher than those in control group( P < 0. 05). Conclusion Permissive hypercapnia ventilation strategy in elderly patients undergoing laparoscopic surgery can effectively optimize the cerebral oxygen metabolism level,improve postoperative cognitive function and reduce intraoperative lung function damage.
Objective To study the effect of permissive hypercapnia ventilation strategy on brain oxygen metabolism,cognitive function and pulmonary function parameters in elderly patients underwent laparoscopic surgery. Methods 110 cases of chronic cholecystitis patients underwent laparoscopic surgery in our hospital from September 2015 to September 2017 were chosen as research objects,ventilation strategies during anesthesia period were reviewed and all patients were divided into control group( n = 57,underwent conventional ventilation strategy),study group( n = 53,underwent permissive hypercapnia ventilation strategy). The differences of brain oxygen metabolism,cognitive function and lung function were compared between two groups. Results 1 h after pneumoperitoneum,SjvO_2 levels in study group was higher than that in control group,CaO_2-CjvO_2,CERO_2 levels were lower than that in control group( P < 0. 05). 24 h after surgery,serum content of BDNF in study group washigher than that in control group,NSE,Aβ,Hcy in study group were lower than those in control group( P < 0. 05). 10 min after pneumoperitoneum and 10 min after release. P peak level in study group was lower than that in control group,Cst,Cdyn levels were higher than those in control group( P < 0. 05). Conclusion Permissive hypercapnia ventilation strategy in elderly patients undergoing laparoscopic surgery can effectively optimize the cerebral oxygen metabolism level,improve postoperative cognitive function and reduce intraoperative lung function damage.
引文
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[19]张斌,王爱红,林群锋,等.miR-129靶向淀粉样前体蛋白对阿尔兹海默症细胞模型的调控作用[J].临床和实验医学杂志,2017,16(24):2422-2425.
[20]Lee HK,Kim SY,Sok SR.Effects of multivitamin supplements on cognitive function,serum homocysteine level,and depression of Korean older adults with mild cognitive impairment in care facilities[J].J Nurs Scholarsh,2016,48(3):223-231.
[21]Yeh YC,Huang MF,Hwang SJ,et al.Association of homocysteine level and vascular burden and cognitive function in middle-aged and older adults with chronic kidney disease[J].Int J Geriatr Psychiatry,2016,31(7):723-730.
[22]刘彬,姚爱军,冯祝余,等.肺保护性通气对截石位腹腔镜全宫切除术患者肺顺应性和氧合的影响[J].现代医院,2015,15(5):42-45.
[23]Sacuto Y,Sacuto T.Early pulmonary compliance increase during cardiac surgery predicted post-operative lung dysfunction[J].Perfusion,2017,32(8):631-638.
[24]Bian W,Chen W,Chao Y,et al.Application of dead space fraction to titrate optimal positive end-expiratory pressure in an ARDS swine model[J].Exp Ther Med,2017,13(4):1572-1577.
[25]Spadaro S,Karbing DS,Mauri T,et al.Effect of positive end-expiratory pressure on pulmonary shunt and dynamic compliance during abdominal surgery[J].Br J Anaesth,2016,116(6):855-861.
[2]Sahay N,Sharma S,Bhadani UK,et al.Effect of pneumoperitoneum and patient positioning on intracranial pressures during laparoscopy:a prospective comparative study[J].J Minim Invasive Gynecol,2018,25(1):147-152.
[3]李琰,刘勇波,刘少艳,等.不同水平Pa CO2对行腹腔镜手术老年患者脑氧代谢和术后认知功能的影响[J].临床医学工程,2016,23(3):293-296.
[4]Fuchs H,Rossmann N,Schmid MB,et al.Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children:A single center experience[J].PLo S One,2017,12(6):e0179974.
[5]任晓玲.不同通气策略对腹腔镜手术患者呼吸力学和血浆内皮素水平影响的对比研究[J].中国医药指南,2016,14(25):34-37.
[6]Abdel-Hady H,Shouman B.Permissive hypercapnia in extremely low-birthweight infants:how far should we go[J]?Acta Paediatr,2017,106(6):1011.
[7]Ma J,Ye H.Effects of permissive hypercapnia on pulmonary and neurodevelopmental sequelae in extremely low birth weight infants:a meta-analysis[J].Springerplus,2016,5(1):764.
[8]Thome UH,Genzel-Boroviczeny O,Bohnhorst B,et al.Permissive hypercapnia in extremely low birthweight infants(PHELBI):a randomised controlled multicentre trial[J].Lancet Respir Med,2015,3(7):534-543.
[9]刘宝鹏,代素敏.肺保护性通气策略对重型颅脑损伤并呼吸衰竭患者脑灌注压及脑氧代谢的影响[J].实用心脑肺血管病杂志,2016,24(1):118-121.
[10]黄晓霞,吕华燕,胡崇辉.呼吸末正压通气对丙泊酚麻醉下腹腔镜胃癌根治术患者脑氧代谢的影响[J].中国内镜杂志,2015,21(2):148-151.
[11]Neunhoeffer F,Sandner K,Wiest M,et al.Non-invasive assessment of cerebral oxygen metabolism following surgery of congenital heart disease[J].Interact Cardiovasc Thorac Surg,2017,25(1):96-102.
[12]Temma T,Yamazaki M,Miyanohara J,et al.Sequential PET estimation of cerebral oxygen metabolism with spontaneous respiration of 15O-gas in mice with bilateral common carotid artery stenosis[J].J Cereb Blood Flow Metab,2017,37(10):3334-3343.
[13]Girard N.Evidence appraisal of Wei C,Yu Y,Chen Y,Wei Y,Ni X.Impact of warming blood transfusion and infusion toward cerebral oxygen metabolism and cognitive recovery in the perioperative period of elderly knee replacement.J Orthop Surg Res.2014;9:8[J].AORN J,2015,102(6):669-673.
[14]Sokoloff MD,Plegue MA,Chervin RD,et al.Phenobarbital and neonatal seizures affect cerebral oxygen metabolism:a near-infrared spectroscopy study[J].Pediatr Res,2015,78(1):91-96.
[15]王楠,何远宏,潘双杰.阿尔茨海默病患者认知功能及血清铜、同型半胱氨酸、尿酸水平、tau和Aβ1-42蛋白的检测[J].郑州大学学报(医学版),2015,50(3):407-410.
[16]李东白,李莎,高露露,等.不同体温及Pa CO2对老年患者腹腔镜术后早期精神改变的影响[J].大连医科大学学报,2017,39(5):465-468.
[17]秦锦标,杨明华,栾丽芹.脑梗死后认知功能障碍患者血清BDNF水平及氟西汀的治疗作用[J].中风与神经疾病杂志,2013,30(1):49-51.
[18]赵国梁,丁明.血清NSE、S100β和Aβ蛋白与老年患者术后认知功能障碍关系的临床研究[J].临床麻醉学杂志,2013,29(10):979-982.
[19]张斌,王爱红,林群锋,等.miR-129靶向淀粉样前体蛋白对阿尔兹海默症细胞模型的调控作用[J].临床和实验医学杂志,2017,16(24):2422-2425.
[20]Lee HK,Kim SY,Sok SR.Effects of multivitamin supplements on cognitive function,serum homocysteine level,and depression of Korean older adults with mild cognitive impairment in care facilities[J].J Nurs Scholarsh,2016,48(3):223-231.
[21]Yeh YC,Huang MF,Hwang SJ,et al.Association of homocysteine level and vascular burden and cognitive function in middle-aged and older adults with chronic kidney disease[J].Int J Geriatr Psychiatry,2016,31(7):723-730.
[22]刘彬,姚爱军,冯祝余,等.肺保护性通气对截石位腹腔镜全宫切除术患者肺顺应性和氧合的影响[J].现代医院,2015,15(5):42-45.
[23]Sacuto Y,Sacuto T.Early pulmonary compliance increase during cardiac surgery predicted post-operative lung dysfunction[J].Perfusion,2017,32(8):631-638.
[24]Bian W,Chen W,Chao Y,et al.Application of dead space fraction to titrate optimal positive end-expiratory pressure in an ARDS swine model[J].Exp Ther Med,2017,13(4):1572-1577.
[25]Spadaro S,Karbing DS,Mauri T,et al.Effect of positive end-expiratory pressure on pulmonary shunt and dynamic compliance during abdominal surgery[J].Br J Anaesth,2016,116(6):855-861.