| 术中脑氧饱和度降低对单肺通气患者术后早期认知功能的影响 |
| Alternative Title | Effects of cerebral oxygen desaturation during single lung entilation on early postoperative cognitive dysfunction
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| 唐羚珊 |
| Thesis Advisor | 石翊飒
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| 2013-05-17
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| Degree Grantor | 兰州大学
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| Place of Conferral | 兰州
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| Degree Name | 硕士
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| Keyword | 脑氧饱和度
术后认知功能障碍
单肺通气
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| Abstract | 目的：观察术中大脑氧饱和度降低对单肺通气患者术后早期认知功能的影响。
方法：本试验选择76名单肺通气肺部手术患者，手术时间预计在45分钟以上，所有患者术前均未用药，且术中镇痛选择在T4，5或T5，6部位行硬膜外置管，术中行桡动脉置管用于有创血压的监测。静脉麻醉诱导后在纤维支气管镜的引导下行双腔支气管插管。术中给予常规监测和脑氧饱和度（regional cerebral oxygen saturation, SctO2）监测。采用简易智力状态监测法（MMSE）分别在术前、术后3小时和24小时对患者进行认知功能检测。MMSE分值下降>2分被视为术后认知功能障碍（postoperative cognitive dysfunction, POCD）。采用Spearman测试对所收集的数据进行相关性检测，发生认知功能障碍的危险度用比值比来表示。P<0.05为差异有统计学意义，数据用中位数（四分卫距）表示。
结果：术后认知功能障碍与患者在阈值下暴露的时间呈正相关，SctO2 < 65% 时，P = 0.018，r2 = 0.272；SctO2 < 60% 时，P = 0.013 , r2 = 0.285；SctO2 < 55% 时，P = 0.010，r2 = 0.297。发生术后早期认知功能障碍比值比的范围在最小2.03倍（在SctO2阈值65%以下短期暴露时间<5分钟）倍到最大9.56倍（在SctO2阈值60%以下暴露时间>30分钟）。
结论：单肺通气肺部手术术后早期认知功能障碍与术中SctO2降低到阈值下暴露的时间成正相关。 |
| Other Abstract | Objective: The objective of this prospective study is to determine effects on cerebral desaturation on early postoperative cognitive function after single lung ventilation.
Methods: Seventy-six patients undergoing lung surgery with single-lung ventilation (SLV) of an expected duration of > 45 min were enrolled. None of the patients received any medication before surgery. Before general anesthesia, an epidural catheter was inserted at T4,5 or T5,6 level for perioperative analgesia. Radial arterial line placement was used for intraoperative invasive blood pressure monitoring. After intravenous anesthesia induction, a double-lumen tube was inserted under bronchoscopic assistance. Monitoring consisted of standard clinical parameters and absolute oximetry (SctO2). The Mini-Mental State Exam (MMSE) test was used to assess cognitive function before operation and at 3h and 24h after operation. A decline of 2 points in MMSE is considered as postoperative cognitive dysfunction (POCD). Data were analyzed using Spearman correlation test; risks for cognitive dysfunction were expressed as odds ratios. P < 0.05 was considered as statistically significant, data are presented as median (interquartile range).
Results: Postoperative cognitive dysfunction correlated at r2 = 0.272, 0.285, 0.297 with patient exposure times to SctO2 < 65% (P = 0.018), < 60% (P = 0.013), < 55% (P = 0.010), respectively. The odds ratio of developing early cognitive dysfunction ranged from 2.03 (95% CI: 0.74 – 5.59) for a short (< 5min) exposure to SctO2 < 65% to a maximum of 9.56 (95% CI: 1.75 – 52.13) when SctO2 was < 60% for more than 30 min.
Conclusions: Early cognitive dysfunction after lung surgery with SLV is positively related to intraoperative decline of SctO2, depending on its degree and time under threshold. |
| URL | 查看原文
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| Language | 中文
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| Document Type | 学位论文
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| Identifier | https://ir.lzu.edu.cn/handle/262010/222689
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| Collection | 学院待认领
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| Affiliation | 临床医学院
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Recommended Citation
GB/T 7714 |
唐羚珊. 术中脑氧饱和度降低对单肺通气患者术后早期认知功能的影响[D]. 兰州. 兰州大学,2013.
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