压力控制通气模式对老年脊柱结核患者术后谵妄的影响

Effect of pressure controlled ventilation on postoperative delirium in elderly patients with spinal tuberculosis

目的探讨压力控制通气(pressure controlled ventilation, PCV)模式对老年脊柱结核患者术后谵妄(postoperative delirium, POD)的影响。方法选择2018年9月—2019年9月浙江大学医学院附属杭州市胸科医院收治的72例老年脊柱结核患者,以随机数字表法分为观察组和对照组,各36例。观察组患者予以PCV模式通气[初始参数:VT=8 mL/kg,氧流量=2 L/min, RR=12次/min, FiO_(2)=60%,I∶E=1∶1.5。术中保持FiO_(2)、I∶E不变,调整VT为6 mg/kg+5 cm H_(2)O(1 cm H_(2)O=0.098 kPa),并使PetCO_(2)保持在33~36 mm Hg水平(1 mm Hg=0.133 kPa)],对照组患者予以常规正压通气(VT=8 mL/kg, RR=12次/min, I∶E=1∶2,PEEP=0 cm H_(2)O)。于术后1周内以意识错乱评估方法(CAM)评估2组患者术后谵妄发生率,对于发生POD的患者予以对症治疗,均未出现因POD死亡病例,分析2组患者谵妄转归情况。结果观察组患者的POD发生率为19.44%(7/36),低于对照组患者的41.67%(15/36),χ^(2)=4.189,P=0.041,而POD持续时间虽短于对照组患者,但差异无统计学意义(t=1.504,P=0.137)。观察组患者的POD转归情况好于对照组(Z=-2.799,P=0.005),且观察组患者的转归率为100.00%(7/7),优于对照组患者的53.33%(8/15),χ^(2)=4.791,P=0.029。结论老年脊柱结核患者术中行压力控制通气有助于减少术后谵妄的发生,并提高术后谵妄转归率,值得临床运用。

Objective To explore the effect of pressure-controlled ventilation(PCV) mode on postoperative delirium(POD) in elderly patients with spinal tuberculosis. Methods A total of 72 elderly patients suffering from spinal tuberculosis and admitted to a hospital from September 2018 to September 2019 were included in the study. They were randomly divided into observation and control groups with a simple random number table method, and each group contained 36 patients. Patients in the observation group received PCV mode ventilation [initial parameters: VT=8 mL/kg, oxygen flow=2 L/min, RR=12 times/min, FiO_(2)=60%, I∶E=1∶1.5. FiO_(2);were maintained during the operation;I∶E was unchanged, VT was adjusted to 6 mg/kg+5 cm H_(2)O(1 cm H_(2)O=0.098 kPa) and Pet CO_(2) was maintained at 33-36 mm Hg(1 mm Hg=0.133 kPa) level). The control group received conventional positive pressure ventilation(VT=8 mL/kg, RR=12 times/min, I∶E=1∶2, PEEP=0 cm H_(2)O). Within 1 week after surgery, the rate of postoperative delirium in both groups was evaluated with the consciousness confusion assessment method. For patients with POD after symptomatic treatment, no case of death due to POD was recorded, and the outcome of delirium in the two groups was analysed. Results The incidence rate of POD in the observation group was 19.44%(7/36), lower than that in the control group(41.67%,15/36). The difference was statistically significant(χ^(2)=4.189, P=0.041). POD continued despite that the time was shorter than that in the control group, and the difference was not statistically significant(t=1.504, P=0.137). The POD outcome of the observation group was better than that of the control group, and the difference was statistically significant(Z=-2.799, P=0.005). The outcome of the observation group was 100.00%(7/7), better than that of the control(53.33%, 8/15). Statistically significant differences were found(χ^(2)=4.791, P=0.029). Conclusion Pressure control ventilation during the operation of elderly patients with spinal tuberculosis can help reduce the incidence of postoperative delirium and increase the postoperative delirium outcome rate and is thus suitable for clinical application.