目的 探究允许性高碳酸血症(permissive hypercapnia,PHC)联合远端缺血预处理(remote ischemic preconditioning,RIPC)对胸腔镜肺癌手术患者脑氧饱和度和术后认知功能的影响.方法 收集择期胸腔镜肺癌手术患者 64 例,按随机数字表法分为对照组和联合组,各 32 例.对照组术中正常通气,联合组给予允许 PHC 并进行 RIPC,PaCO2 保持在45～50mmHg(1mmHg=0.133kPa).记录术前(T0)、单肺通气后 10min(T1)、单肺通气后 30min(T2)、肺复张后 10min(T3)及手术结束时(T4)5 个时间点的局部脑氧饱和度(regional cerebral oxygenregional oxygen saturation,rSO2),颈内静脉血氧饱和度(oxygen saturation of jugular venous blood,SjvO2)、计算脑氧摄取率(cerebral oxygen extraction rate,CERO2)和脑动静脉血氧含量差值(CaO2-CjvO2).监测上述 5 个时间点心率(heart rate,HR)及平均动脉压(mean arterial pressure,MAP),记录术前 1d和术后 1d、3d认知功能评分;术前、术后 24h及术后 48h检测血清中神经元特异性烯醇化酶(neuronspecific enolase,NSE)、β淀粉样蛋白(beta-amyloid,Aβ)及S100β蛋白(S100β);比较两组患者手术相关指标及术后不良反应情况.结果 T1至T4时刻联合组患者rSO2、SjvO2高于对照组而CaO2-CjvO2及CERO2 低于对照组.两组患者T0至T4时刻MAP及HR差异无统计学意义.术后1d联合组患者的简易智能精神状态检查量表(mini-mental state examination,MMSE)评分比对照组明显增高,术后 24h及术后 48h联合组患者血清中NSE、Aβ及S100β水平较对照组降低(P<0.05).两组患者不良反应发生率及手术相关情况差异无统计学意义(P>0.05).结论 PHC联合RIPC可提高胸腔镜肺癌手术患者的脑氧饱和度,改善脑氧代谢水平,降低血清中神经元特异性烯醇化酶、β淀粉样蛋白及S100β蛋白水平,减轻术后认知功能障碍.
Objective To explore the effects of remote ischemic preconditioning combined with permissive hypercapnia on brain oxygen saturation and postoperative cognition in patients which undergoing thoracoscopic lung cancer surgery.Methods A collection of 64 patients elective requiring thoracoscopic lung cancer surgery who were divided into control group and combined group according to the randomized grouping method,with 32 cases in each group.The PaCO2 in the control group of patient was maintained at normal,and patients in the combination group were given permissive hypercapnia ventilation strategies and performed remote ischemic preconditioning,PaCO2 is maintained at 45-50mmHg(1mmHg=0.133kPa).Record the cerebral oxygen saturation(rSO2)at the five time points before operation(T0),10min after one lung ventilation(T1),30min after one lung ventilation(T2),10 min after lung recruitment(T3)and the end of surgery(T4),measured the internal jugular venous blood oxygen saturation(SjvO2)and calculated cerebral arteriovenous blood oxygen content difference(CaO2-CjvO2),brain oxygen uptake rate(CERO2).Monitored the average arterial pressure(MAP)and heart rate(HR)of the hemodynamic indicators at the above five time points.The scores of cognitive function were recorded 1 day before operation and 1 day and 3 days after operation;detected the levels of serum neuron-specific enolase(NSE),amyloid β(Aβ)and S100β protein(S100β)in 1 day before surgery,24hours after surgery and 48hours after surgery;Comparison of postoperative related indicators and adverse reactions between the patients of two groups.Results The rSO2 and SjvO2 of combined group were higher than control group in the T1-T4,but CaO2-CjvO2 and CERO2 were lower than those of control group.There was no significant difference in HR and MAP between two groups from T0-T4.The mini-mental state examination(MMSE)score of the combined group was significantly higher than that of the control group on the 1 day after operation.The level of serum NSE,Aβ and S100β in the combined group was lower than those of control group at 24hours and 48hours after operation.There was no significant difference in incidence of postoperative adverse reactions and postoperative related indexes between the two groups.Conclusion Permissive hypercapnia combined with remote ischemic preconditioning can increase cerebral oxygen saturation in patients undergoing thoracoscopic lung cancer surgery,improve cerebral oxygen metabolism and reduce the levels of serum neuron-specific enolase,β-amyloid protein and S100β protein,decrease the postoperative cognitive dysfunction.
陆微;朱丹艳;姜小峰;饶效;彭文勇
金华市中心医院防保科,浙江金华 321000金华市中心医院麻醉科,浙江金华 321000金华市中心医院心胸外科,浙江金华 321000
临床医学
允许性高碳酸血症;远端缺血预处理;肺癌;术后认知功能障碍
Permissive hypercapnia;Remote ischemic preconditioning;Lung cancer;Postoperative cognition dysfunction
《中国现代医生》 2024 (014)
19-23 / 5
浙江省医药卫生科技计划项目(2020KY345,2022KY1328)
10.3969/j.issn.1673-9701.2024.14.005
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