肺开放通气策略对胸腔镜肺癌根治术老年患者术后认知功能的影响

The effect of open-lung approach on postoperative cognitive function in elderly patients undergoing thoracoscopic lung cancer radical surgery

目的探讨肺开放通气策略(OLA)对胸腔镜肺癌根治术老年患者术后认知功能的影响。方法选择2020年9月至2021年7月于河北省人民医院行胸腔镜肺癌根治术的老年患者106例,采用随机数字表法分为常规机械通气组(PV组)和OLA组,每组53例。于术前1 d(T_(0))、术后1 d(T_(4))、术后3 d(T_(5))及术后7 d(T_(6))采用简易精神状态评价量表(MMSE)评分法评价患者认知功能,记录术后7 d内认知功能障碍的发生率。于双肺通气10 min(T_(1))、单肺通气30 min(T_(2))、再次恢复双肺通气10 min(T_(3))行血气分析记录动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))和颈静脉球部血氧饱和度(SjvO_(2)),计算氧合指数和脑氧摄取率(CERO_(2))。采用酶联免疫吸附试验法检测T_(1)~T_(4)时点血浆白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平。结果OLA组T_(4)、T_(5)时点MMSE评分高于PV组,差异均有统计学意义(均P<0.05),T6时点2组MMSE评分比较,差异无统计学意义(P>0.05)。OLA组术后认知功能障碍发生率低于PV组[13.2%(7/53)比28.3%(15/53)],差异有统计学意义(P=0.013)。T_(2)时点OLA组PaO_(2)、氧合指数和SjvO_(2)均高于PV组,CERO_(2)低于PV组(均P<0.05),T_(1)~T_(3)时点2组PaCO_(2)比较差异均无统计学意义(均P>0.05)。OLA组T_(2)~T_(4)时点血浆IL-6和TNF-α水平均低于PV组(均P<0.05)。结论OLA能够改善胸腔镜肺癌根治术老年患者术后早期认知功能障碍,减轻机体炎症反应,降低脑氧代谢率及改善氧合。

Objective To discuss the effect of open-lung approach(OLA)on postoperative cognitive function in elderly patients undergoing thoracoscopic lung cancer radical surgery.Methods From September 2020 to July 2021,106 patients who were scheduled for elective thoracoscopic lung cancer radical surgery in Hebei General Hospital were collected.The patients were divided into regulation ventilation group(PV group)and OLA group according to the random number table method,with 53 cases in each group.Patients′cognitive function was evaluated by Mini-Mental State Examination(MMSE)at 1 d before operation(T_(0)),1 d after operation(T_(4)),3 d after operation(T_(5))and 7 d after operation(T_(6)).The incidence of cognitive dysfunction within 7 d after operation was recorded.At 10 min of two-lung ventilation(T_(1)),30 min of one-lung ventilation(T_(2)),10 min after restoration of two-lung ventilation(T_(3)),arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))and jugular bulb oxygen saturation(SjvO_(2))were recorded,and oxygenation index and cerebral oxygen uptake rate(CERO_(2))were calculated.The plasma levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)were measured by enzyme-linked immunosorbent assay from T_(1)to T_(4).Results The scores of MMSE at T_(4)and T_(5)in OLA group were higher than those in PV group(both P<0.05).The scores of MMSE at T6in two groups were not statistically different(P>0.05).The incidence of postoperative cognitive dysfunction(POCD)in OLA group was lower than that in PV group[13.2%(7/53)vs 28.3%(15/53)](P=0.013).PaO_(2),oxygenation index and SjvO_(2)in OLA group at T_(2)were higher than those in PV group,while CERO_(2)was lower than that in PV group(all P<0.05).PaCO_(2)in T_(1)-T_(3)had no significant difference between the two groups(all P>0.05).The levels of serum IL-6 and TNF-α at T_(2)-T_(4)in OLA group were lower than those in PV group(all P<0.05).Conclusion OLA can improve early POCD in elderly patients undergoing thoracoscopic lung cancer radical surgery,alleviate the inflammatory response,reduce the cerebral oxygen metabolism rate and improve oxygenation.