孙诗媛 1张志强 1边庆虎 1高礼 1孟利江 1张山1
作者信息
- 1. 河北医科大学第二医院麻醉科,河北 石家庄 050000
- 折叠
摘要
Abstract
Objective To investigate the effects of permissive hypercapnia(PHC)combined with goal-directed fluid therapy(GDFT)on cerebral oxygen metabolism and postoperative cognitive function in gynecological patients undergoing laparoscopic surgery.Methods From January to December 2021,60 patients undergoing laparoscopic surgery for gynecological tumors in the Eastern Hospital of the Second Hospital of Hebei Medical University were selected and divided into PHC group(group P)and conventional ventilation group(group C)by random number table method.Both groups were treated with GDFT for rehydration.Group P:tidal volume 6-8ml/kg,I∶E=1∶2,PaCO2 46-55mmHg,pH 7.25-7.35;group C:tidal volume 10-12ml/kg,I∶E=1∶2,PaCO2 35-45mmHg,pH 7.35-7.45.The infusion volume,bleeding volume,urine volume,pneumoperitoneum time,T position time,and operation time were recorded betwwen the two groups.HR,MAP,rSO2,EtCO2,PaCO2 and pH were recorded at the time of entering operation room(T0),5 min after tracheal intubation(T1),30 min after T position(T2),60 min after T position(T3),90 min after T position(T4)and the end of operation(T5).Thejugular bulb blood oxygen saturation(SjvO2),arteriovenous blood oxygen content difference(Da-jvO2),cerebral oxygen uptake rate(CERO2)anddifference of arterial and venous lactic acid content(Da-jvLac)was recorded or calculated.The nerve injury markers such as NSE and S100β protein concentration was measured.and the MMSE score on preoperative 1d(M0),postoperative 1d(M1)and 3 d(M2)was observed.Results There were no statistically significant differences in HR,MAP,infusion volume,bleeding volume,urine volume,pneumoperitoneum time,T position time,operation time,Da-jvLac between the two groups(P＞0.05).At T2-T4,rSO2,EtCO2,PaCO2 and SjvO2 in group P were higher than those in group C,while pH,CERO2 and Da-jvO2,S100β and NSE were lower than those in group C(P＜0.05).The MMSE score of group P at Ml was higher than that of group C,and the difference was statistically significant(P＜0.05).Conclusion Permissive hypercapnia combined with goal-directed fluid therapy can optimize perioperative fluid management,improve cerebral oxygen metabolism and postoperative cognitive function in patients undergoing gynecological laparoscopic surgery.关键词
允许性高碳酸血症/目标导向液体治疗/腹腔镜手术/脑氧代谢/认知功能Key words
Permissive hypercapnia/Goal-directed fluid therapy/Gynecological laparoscopic surgery/Cerebral oxygen metabolism/Postoperative cognitive分类
医药卫生
