允许性高碳酸血症对沙滩椅体位肩关节镜手术患者脑氧饱和度和术后认知功能的影响*

Effects of permissive hypercapnia ventilation on cerebral oxygen saturation and postoperative cognitive function in patients undergoing arthroscopic shoulder surgery in beach chair position*

摘要:

摘要：目的??探讨允许性高碳酸血症对沙滩椅体位（BCP）肩关节镜手术患者脑氧饱和度（rSO2）及术后认知功能的影响。方法 选取择期全身麻醉下老年BCP肩关节镜手术患者86例，年龄60～79岁，体重42～78 kg，美国麻醉医师协会（ASA）分级Ⅰ～Ⅲ级，采用随机数字表法将患者随机分为两组，正常呼气末二氧化碳分压（PETCO2）组（C组，n?=?43）和允许性高碳酸血症（PHC）组（H组，n?=?43）。记录麻醉前（T0）、气管插管后5 min（T1）、BCP后5?min（T2）、BCP调整麻醉机[C组维持PETCO2 35～40?mmHg，H组维持PETCO2 50～55?mmHg，控制平均动脉压（MAP）60～65?mmHg]后5 min（T3）、30?min（T4）、1?h（T5）和改为平卧位后5 min（T6）时点rSO2变化，记录脑氧饱和度下降事件（CDE）发生情况、麻醉复苏情况和不良反应。于T0、T6和T7时间点抽取外周静脉血测定Aβ-42、S100β蛋白浓度。术前1?d、术后1和7?d采用简易智能精神状态检查量表（MMSE）评价术后认知功能。结果 C组患者在T1～T6时rSO2较T0时低，H组T1～T3时点较T0时低，差异有统计学意义（P??0.05）；两组患者术后1?d MMSE评分明显低于术前（P?

关键词:关键词： 允许性高碳酸血症;沙滩椅体位;肩关节镜;脑氧饱和度;术后认知功能障碍

Abstract:

Abstract: Objective?To evaluate the effect of permissive hypercapnia ventilation on the cerebral oxygen saturation and postoperative cognitive function in patients undergoing arthroscopic shoulder surgery in beach chair position (BCP).?Methods?86 ASA Ⅰ ~ Ⅲ patients, aged 60?~?79 y, weight 42?~?78 kg, underwent elective arthroscopic shoulder surgery in the beach chair position (BCP), were divided into 2 groups using random number table method: control group (group C, n?=?43, PETCO2 35 ~ 40?mmHg) and permissive hypercapnia group (group H, n?=?43, PETCO2 50?~?55?mmHg). The rSO2 was monitored by using the near infrared specrometer (NIRS). Record the regional cerebral oxygen saturation (rSO2) in the time before anesthesia (T0), 5 min after induction (T1), 5 min after BCP (T2), 5 min after ventilation (the PETCO2 was maintained at 35 ~ 40 mmHg in the group C, and 50 ~ 55 mmHg in the group H by adjusting the anaesthesia machine, the mean arterial pressure was maintained at 60 ~ 65 mmHg) (T3), 30 min after ventilation (T4), 1 h after ventilation (T5) and 5 min after supine (T6). The occurrence of cerebral desaturation event (CDE), anaesthetic resuscitation and adverse reactions. Blood samples were taken from the peripheral venous at time of T0, T6 and T7 to check the protein concentrations of Aβ-42 and S100β. Cognitive function was assessed by mini-mental state examination (MMSE) at 1 day before operation and 1 d, 7 d after operation.?Results?Compared with T0, the rSO2 in group C was significantly decreased at T1?~?T6 (P??0.05). Compared with the time before operation, the MMSE score of two groups decreased at 1?d after the operation (P?

Key words:Keywords: permissive hypercapnia; beach chair position; arthroscopic shoulder; cerebral regional oxygen saturation; postoperative cognitive dysfunction