允许性高碳酸血症对老年胸腔镜食管癌根治术患者术后谵妄的影响

doi:10.11958/20220699

天津医药 ›› 2023, Vol. 51 ›› Issue (3): 282-285.doi: 10.11958/20220699

允许性高碳酸血症对老年胸腔镜食管癌根治术患者术后谵妄的影响

邵艳梅(), 宋洁, 杨梦思, 黄孝慈, 汤昕宇, 胡宪文()

麻醉与围术期医学安徽普通高校重点实验室，安徽医科大学第二附属医院麻醉与围术期医学科（邮编230601

收稿日期:2022-05-09 修回日期:2022-10-01 出版日期:2023-03-15 发布日期:2023-03-02
通讯作者: 胡宪文 E-mail:1806378488@qq.com;huxianwen001@126.com
作者简介:邵艳梅（1997），女，硕士在读，主要从事术后谵妄方面研究。E-mail：1806378488@qq.com
基金资助:
安徽省教育厅基金(KJ2021ZD0030);安徽省卫建委基金(AHWJ2021a017);中科院合肥研究院联合基金(LHJJ202004)

The effect of permissibility hypercapnia on postoperative delirium in elderly patients undergoing thoracoscopic radical surgery of esophageal cancer

SHAO Yanmei(), SONG Jie, YANG Mengsi, HUANG Xiaoci, TANG Xinyu, HU Xianwen()

Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Department of Anesthesiology and Perioperative Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China

Received:2022-05-09 Revised:2022-10-01 Published:2023-03-15 Online:2023-03-02
Contact: HU Xianwen E-mail:1806378488@qq.com;huxianwen001@126.com

邵艳梅, 宋洁, 杨梦思, 黄孝慈, 汤昕宇, 胡宪文. 允许性高碳酸血症对老年胸腔镜食管癌根治术患者术后谵妄的影响[J]. 天津医药, 2023, 51(3): 282-285.

SHAO Yanmei, SONG Jie, YANG Mengsi, HUANG Xiaoci, TANG Xinyu, HU Xianwen. The effect of permissibility hypercapnia on postoperative delirium in elderly patients undergoing thoracoscopic radical surgery of esophageal cancer[J]. Tianjin Medical Journal, 2023, 51(3): 282-285.

摘要/Abstract

摘要： Objective To investigate the effect of permissible hypercapnia (PHY) on postoperative delirium (POD) in elderly patients undergoing thoracoscopic radical resection of esophageal cancer. Methods A total of 92 elderly patients (≥65 years old) who underwent thoracoscopic radical resection of esophageal cancer were randomly divided into the normal arterial partial pressure of carbon dioxide [p(CO₂) was controlled at 35-45 mmHg] group (N group, 46 cases) and the mild PHY [p(CO₂) was controlled at 46-55 mmHg] group (H group, 46 cases). Data of mean arterial pressure (MAP), heart rate (HR) and cerebral oxygen saturation (rSO₂) were recorded when patients were awake (T₀), intubated (T₁), pneumothorax 0.5 h (T₂), pneumothorax 1 h (T₃) and vented for 10 min (T₄). Intraoperative fluid volume, urine volume, blood loss and ephedrine dosage were recorded in the two groups of patients. Visual analogue scale (VAS) was recorded for three consecutive days after operation, and the occurrence of POD was assessed by Delirium Diagnostic Scale (CAM). Results Compared with T₀, MAP, HR and rSO₂ were decreased at T₁-T₄ in the N group and the H group (P<0.05). Compared with the group N, MAP and rSO₂ were higher at T₂-T₄ in the group H (P<0.05). Correlation analysis showed that rSO₂ was positively correlated with p(CO₂) at T₂-T₄ in the two groups of patients (r_s=0.438, 0.646 and 0.554, all P<0.01). There were no significant differences in infusion volume, urine volume and blood loss between the two groups of patients (P>0.05). Compared with the group N, the amount of ephedrine was lower in the group H [(5.8±3.2) mg vs. (4.0±2.5) mg, t=3.014, P<0.01]. The VAS score were gradually decreased 3 days after operation in the two groups (P<0.05), and there was no significant difference in VAS scores between the two groups (P>0.05). Compared with the group N, the incidence of POD was lower in the group H (8.7% vs. 23.9%, χ²=3.903, P<0.05). Conclusion PHY ventilation strategy in elderly patients undergoing thoracoscopic radical resection of esophageal cancer is helpful to optimize the balance of cerebral oxygen supply and demand, increase rSO₂, and reduce the incidence of POD.

关键词: 胸腔镜检查, 食管肿瘤, 谵妄, 手术后并发症, 高碳酸血, 允许性高碳酸血症

Key words: thoracoscopy, esophageal neoplasms, delirium, postoperative complications, hypercapnia, permissive hypercapnia

中图分类号:

R614.2

图/表 4

参考文献 16

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组别	性别（女/男）	年龄（岁）	BMI （kg/m²）	ASA分级（Ⅱ/Ⅲ）	MMSE评分（分）
N组	10/36	70.4±4.1	23.0±2.5	32/14	27.6±1.5
H组	13/33	70.0±3.3	22.4±1.8	31/15	27.8±1.5
t或χ²	0.522	0.615	1.365	0.050	0.825

组别	性别（女/男）	年龄（岁）	BMI （kg/m²）	ASA分级（Ⅱ/Ⅲ）	MMSE评分（分）
N组	10/36	70.4±4.1	23.0±2.5	32/14	27.6±1.5
H组	13/33	70.0±3.3	22.4±1.8	31/15	27.8±1.5
t或χ²	0.522	0.615	1.365	0.050	0.825

时点	组别	MAP（mmHg）	HR（次/min）	rSO₂
T₀	N组 H组	93.6±6.5 92.3±7.2	69.3±8.8 69.0±8.1	0.69±0.03 0.68±0.03
T₁	N组 H组	83.0±6.8^a 82.3±7.7^a	67.7±6.9^a 67.7±7.3^a	0.65±0.03^a 0.64±0.03^a
T₂	N组 H组	82.2±6.4^a 85.2±6.1^aA	65.0±6.7^a 66.8±6.4^a	0.65±0.02^a 0.67±0.02^aA
T₃	N组 H组	81.1±6.2^a 85.6±8.3^aA	62.8±6.7^a 65.3±7.3^a	0.63±0.02^a 0.66±0.03^aA
T₄	N组 H组	79.0±6.8^a 85.0±7.5^aA	62.1±6.2^a 64.2±7.8^a	0.62±0.03^a 0.65±0.03^aA

时点	组别	MAP（mmHg）	HR（次/min）	rSO₂
T₀	N组 H组	93.6±6.5 92.3±7.2	69.3±8.8 69.0±8.1	0.69±0.03 0.68±0.03
T₁	N组 H组	83.0±6.8^a 82.3±7.7^a	67.7±6.9^a 67.7±7.3^a	0.65±0.03^a 0.64±0.03^a
T₂	N组 H组	82.2±6.4^a 85.2±6.1^aA	65.0±6.7^a 66.8±6.4^a	0.65±0.02^a 0.67±0.02^aA
T₃	N组 H组	81.1±6.2^a 85.6±8.3^aA	62.8±6.7^a 65.3±7.3^a	0.63±0.02^a 0.66±0.03^aA
T₄	N组 H组	79.0±6.8^a 85.0±7.5^aA	62.1±6.2^a 64.2±7.8^a	0.62±0.03^a 0.65±0.03^aA

组别	输液量（mL）	尿量（mL）	出血量（mL）	麻黄素（mg）
N组	2 451.1±508.1	747.8±287.3	186.6±102.0	5.8±3.2
H组	2 484.8±454.5	753.3±253.9	175.2±100.8	4.0±2.5
t	0.335	0.096	0.540	3.014^＊＊

允许性高碳酸血症对老年胸腔镜食管癌根治术患者术后谵妄的影响

The effect of permissibility hypercapnia on postoperative delirium in elderly patients undergoing thoracoscopic radical surgery of esophageal cancer

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组别	术后1 d	术后2 d	术后3 d
N组	2.8±1.0	2.3±0.9^a	1.9±0.8^a
H组	2.8±0.9	2.3±0.9^a	1.9±0.8^a

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