中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2012年
9期
1054-1057
,共4页
罗宏%陶凡%汪国香%黄丽霞%范皓%曲丕盛
囉宏%陶凡%汪國香%黃麗霞%範皓%麯丕盛
라굉%도범%왕국향%황려하%범호%곡비성
高碳酸血%呼吸,人工%氧%氧耗量%脑:认知障碍%老年人
高碳痠血%呼吸,人工%氧%氧耗量%腦:認知障礙%老年人
고탄산혈%호흡,인공%양%양모량%뇌:인지장애%노년인
Hypercapnia%Respiration,artificial%Oxygen%Oxygen consumption%Brain%Cognition disorders%Aged
目的 探讨允许性高碳酸血症机械通气对老年患者脑氧代谢和术后认知功能的影响.方法 择期全麻下腹部手术老年患者120例,年龄65 ~ 80岁,体重45 ~ 66 kg,ASA分级Ⅰ~Ⅲ级,采用随机数字表法,将患者随机分为2组(n=60):常规通气组(R组)和允许性高碳酸血症机械通气组(H组).H组通气参数:VT 6~8ml/kg,RR 12~ 14次/min,吸呼比1:2,维持PaC02 45 ~ 65 mm Hg,pH值>7.2,R组通气参数:VT10 ~ 12 ml/kg,RR 14~ 16次/min,吸呼比1:2,维持PaCO2 35~ 45 mm Hg.于气管插管即刻(T0)、气管插管后5 min(T1)、15min(T2)、3O min(T3)时经桡动脉、颈内静脉球部采集血样行血气分析,计算动脉-颈内静脉血氧含量差(Da-jvO2)和脑氧摄取率(CERO2).于术前1d、术后24、48 h、1、2周时采用简易智能状态检查表(MMSE)评分评价术后认知功能.结果 与R组相比,H组T1~T3时PET CO2和paCO2升高,pH值、Da-jvO2和CERO2降低,术后MMSE评分升高,术后认知功能障碍发生率降低(P< 0.05或0.01);与T0时相比,H组T1~T3时PETCO2和PCO2升高,pH值、Da-jvO2和CERO2降低,2组T1 ~T3时Da-jvO2和CERO2降低,术后24 h~1周MMSE评分降低(P<0.01).结论 允许性高碳酸血症机械通气可改善老年患者术中脑氧代谢,减轻术后认知功能障碍.
目的 探討允許性高碳痠血癥機械通氣對老年患者腦氧代謝和術後認知功能的影響.方法 擇期全痳下腹部手術老年患者120例,年齡65 ~ 80歲,體重45 ~ 66 kg,ASA分級Ⅰ~Ⅲ級,採用隨機數字錶法,將患者隨機分為2組(n=60):常規通氣組(R組)和允許性高碳痠血癥機械通氣組(H組).H組通氣參數:VT 6~8ml/kg,RR 12~ 14次/min,吸呼比1:2,維持PaC02 45 ~ 65 mm Hg,pH值>7.2,R組通氣參數:VT10 ~ 12 ml/kg,RR 14~ 16次/min,吸呼比1:2,維持PaCO2 35~ 45 mm Hg.于氣管插管即刻(T0)、氣管插管後5 min(T1)、15min(T2)、3O min(T3)時經橈動脈、頸內靜脈毬部採集血樣行血氣分析,計算動脈-頸內靜脈血氧含量差(Da-jvO2)和腦氧攝取率(CERO2).于術前1d、術後24、48 h、1、2週時採用簡易智能狀態檢查錶(MMSE)評分評價術後認知功能.結果 與R組相比,H組T1~T3時PET CO2和paCO2升高,pH值、Da-jvO2和CERO2降低,術後MMSE評分升高,術後認知功能障礙髮生率降低(P< 0.05或0.01);與T0時相比,H組T1~T3時PETCO2和PCO2升高,pH值、Da-jvO2和CERO2降低,2組T1 ~T3時Da-jvO2和CERO2降低,術後24 h~1週MMSE評分降低(P<0.01).結論 允許性高碳痠血癥機械通氣可改善老年患者術中腦氧代謝,減輕術後認知功能障礙.
목적 탐토윤허성고탄산혈증궤계통기대노년환자뇌양대사화술후인지공능적영향.방법 택기전마하복부수술노년환자120례,년령65 ~ 80세,체중45 ~ 66 kg,ASA분급Ⅰ~Ⅲ급,채용수궤수자표법,장환자수궤분위2조(n=60):상규통기조(R조)화윤허성고탄산혈증궤계통기조(H조).H조통기삼수:VT 6~8ml/kg,RR 12~ 14차/min,흡호비1:2,유지PaC02 45 ~ 65 mm Hg,pH치>7.2,R조통기삼수:VT10 ~ 12 ml/kg,RR 14~ 16차/min,흡호비1:2,유지PaCO2 35~ 45 mm Hg.우기관삽관즉각(T0)、기관삽관후5 min(T1)、15min(T2)、3O min(T3)시경뇨동맥、경내정맥구부채집혈양행혈기분석,계산동맥-경내정맥혈양함량차(Da-jvO2)화뇌양섭취솔(CERO2).우술전1d、술후24、48 h、1、2주시채용간역지능상태검사표(MMSE)평분평개술후인지공능.결과 여R조상비,H조T1~T3시PET CO2화paCO2승고,pH치、Da-jvO2화CERO2강저,술후MMSE평분승고,술후인지공능장애발생솔강저(P< 0.05혹0.01);여T0시상비,H조T1~T3시PETCO2화PCO2승고,pH치、Da-jvO2화CERO2강저,2조T1 ~T3시Da-jvO2화CERO2강저,술후24 h~1주MMSE평분강저(P<0.01).결론 윤허성고탄산혈증궤계통기가개선노년환자술중뇌양대사,감경술후인지공능장애.
Objective To investigate the effects of permissive hypercapnia ventilation on cerebral oxygen metabolism and postoperative cognitive function in elderly patients.Methods One hundred and twenty ASA Ⅰ-Ⅲ patients,aged 65-80 yr,undergoing elective lower abdominal surgery under general anesthesia,were randomly divided into 2 groups (n=60 each): routine ventilation group (group R) and permissive hypercapnia ventilation group (group H).In group H,VT=6-8 ml/kg,RR=12-14 bpm,I: E=1: 2,and PaCO2 was maintained at 45-65 mm Hg and pH value > 7.2,while in group R,VT=10-12 ml/kg,RR=14-16 bpm,I:E=1:2,and PaCO2 was maintained at 35-45 mm Hg.Blood samples were taken from the radial artery and jugular bulb for blood gas analyses at 0,5,15 and 30 min after tracheal intubation (T0.3).Cerebral A-V O2 content differences (Da-jvO2)and cerebral O2 extraction rate (CERO2) were calculated at the same time.Cognitive function was assessed by Mini-Mental State Examination (MMSE) at 1 day before operation,and 24 h,48 h,1 week and 2 weeks after operation.Results Compared with group R,PEr CO2 andPaCO2 were significantly increased,and pH value,Da-jvO2 and CERO2 were significantly decreased at T1.3,MMSE score was significantly increased after operation,and the incidence of post-operative cognitive dysfunction was significantly decreased after operation (P < 0.05 or0.01).Compared with the baseline value at T0,Da-jvO2 and CERO2 were significantly decreased at T1-3 in both groups,PETCO2 and PaCO2 were significantly increased,and pH value,Da-jvO2 and CERO2 were significantly decreased at T1-3 in group H,and MMSE score was significantly decreased at 24 h,48 h,1 week and 2 weeks after operation in both groups (P < 0.01).Conclusion Permissive hypercapnia ventilation can improve the cerebral oxygen metabolism during operation,and reduce post-operative cognitive dysfunction in the elderly patients.