摘要
目的观察术中调整动脉血二氧化碳分压（PaCO2），对非体外循环下冠脉搭桥术（OPCAB）患者术后认知功能的影响。方法OPCAB患者30例，随机分成G1组（n=15），术中动脉血PaCO2维持在35～39mmHg范围内；G2组（n=15），术中使PaCO2控制在40～45mmHg。分别于吻合前（T1）、第一支远端吻合5min（T2）、第二支吻合5min（T3）、第三支吻合5min（T4）以及吻合完毕20min（T5）时间点记录连续心排指数（CCI）、混合静脉血氧饱和度（SvO2）、脑氧饱和度（rSO2）和PaCO2等数据。采用修订长谷川智能量表（HDS-R）和日常生活功能水平量表（ADL）对患者进行认知功能评价。结果术前、术后HDS-R和术前ADL评分，两组之间没有显著差异；G1组HDS-R评分术后较术前明显降低（P〈0．05），而G2组则没有显著差异。两组的rSO2在T2、T3、T4和T5时间点均较T1有显著降低（P〈0．05或P〈0．01）；而G2组各时间点的rSO2均比G1组显著增高（P〈0．05或P〈0．01）。结论血管吻合时较高的PaCO2可以提高脑氧饱和度，从而减少OPCAB术后认知功能障碍的发生。
Objective To observe the effect of PaCO2 modulating during operation on post-operative cognitive function of patients undergoing off-pump coronary artery（OPCAB）. Methods Thirty patients undergoing OPCAB were randomly divided into traditional group （G1 , n = 15） and modulated group （ G2, n = 15）. During operation, PaCO2 in G1 maintained 35 mmHg to 39 mmHg with relatively fixed ventilation parameters setting, and PaCO2 in G2 ranged from 40 mmHg to 45 mmHg by adjusting ventilation parameters. Continuous cardiac output index （CCI） , SvO2, regional cerebral O2 saturation （ rSO2 ） and PaCO2 were recorded before distal anastomosis （T1 ） , at 5 min of the first distal vessel anastomosis （ T2 ）, second distal vessel anastomosis （ T3 ） and third distal vessel anastomosis （T4） , and 20 min after the completion of coronary artery anastomoses. HDS-R and ADL were used to examine the patients＇ cognitive function. Results There were no significant differences in pre- and post-operative HDS-R and pre-operative ADL scores between groups. The score of post-HDS-R in G1 was obviously lower than that of pre-HDS- R （P 〈 0.05） , while there was no such difference in G2. rSO2of the two groups at time point T1 ,T2, T3, T4 and T5 in G2 was significantly higher than that in G1 （P 〈0.05 or P 〈0.01 ） , while rSO2 at T2.T3,T4 and T5 in each group all declined significantly （P 〈0.05 or P 〈0.01 ）. Conclusion It suggests that rSO2 can be elevated with PaCO2 during operation, and therefore may improve the post-operative cognitive function of patients undergoing OPCAB.
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2006年第3期288-290,共3页
Journal of Shanghai Jiao tong University:Medical Science
