近红外光谱仪监测脑氧饱和度在老年结直肠癌根治术中的应用价值

Application value of near-infrared spectrometer in monitoring cerebral oxygen saturation during radical operation of senile colorectal cancer

目的探讨利用近红外光谱仪(near infrared spectrometer,NRIS)监测脑氧饱和度(brain oxygen saturation,rSO_(2))在老年结直肠癌根治术中的应用价值。方法前瞻性纳入于本院择期行结直肠癌根治术的老年直肠癌患者120例为研究对象,使用随机数字表法随机分为常规通气组(对照组)和NRIS监测技术联合机械通气组(研究组),各60例。比较2组术前(T0)、气腹前5 min(T1)、气腹后20 min(T2)、气腹后1 h(T3)、气腹后2 h(T4)及气腹结束后20 min(T5)等各个时间点的动脉血气分析结果和动脉血CO_(2)分压(carbon dioxide partial pressure,PaCO_(2))、动脉血氧饱和度(arterial oxygen saturation,SaO_(2))变化,并应用蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)分别评估患者手术前1 d(M0),手术后1 d(M1),4 d(M2),7 d(M3)时的认知功能,采用酶联免疫吸附法对其血清皮质醇和中枢神经特异蛋白(S-100β)含量进行检测,并记录组患者术中rSO_(2)变化及术后神经并发症情况。结果2组Hb、Lac水平比较组间、时点间、组间·时点间交互作用比较差异无统计学意义(P>0.05),2组PaCO_(2)、rSO_(2)、pH比较组间、时点间差异无统计学意义(P>0.05),2组PaCO_(2)、pH组间与时点间交互作用比较差异无统计学意义(P>0.05),2组rSO_(2)组间与时点间交互作用比较差异有统计学意义(P<0.05),2组MoCA评分均随着时间延长先降低后升高,其时点间、组间与时点间交互作用比较差异有统计学意义(P<0.05),组间比较差异无统计学意义(P>0.05),2组术中均未发生重度脑缺氧,研究组术中轻度、中度脑缺氧发生率及术后谵妄和手术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生率低于对照组,差异有统计学意义(P<0.05)。术前,2组血清皮质醇和S-100β含量比较差异无统计学意义(P>0.05);术后,2组血清皮质醇和S-100β含量均高于术前,研究组S-100β含量高于对照组,差异有统计学意义(P<0.05),2组皮质醇水平比较差异无统计学意义(P>0.05)。结论利用NRIS监测技术联合机械通气可显著提高老年结直肠患者在结直肠癌根治术中的rSO_(2),有效降低其术中发生脑缺氧和术后并发神经性并发症的风险,有利于减轻患者术后早期认知功能障碍。

Objective To investigate the application value of near-infrared spectrometer(NRIS)in monitoring cerebral oxygen saturation during radical operation of senile colorectal cancer(CRC).Methods In total,120 elderly patients with rectal cancer who underwent elective radical surgery for CRC in our hospital were prospectively included as the research subjects.They were randomly divided into a conventional ventilation group(control group,n=60)and a NRIS monitoring technology combined with mechanical ventilation group(research group,n=60)using a random number table method.The arterial blood gas analysis results,as well as the changes in arterial blood carbon dioxide(CO_(2))partial pressure(PaCO_(2))and arterial oxygen saturation(SaO_(2)),before surgery(T0),at 5 min before pneumoperitoneum(T1),20 min after pneumoperitoneum(T2),1 h after pneumoperitoneum(T3),2 h after pneumoperitoneum(T4),and 20 min after pneumoperitoneum(T5)were compared between two groups,and cognitive function of the patients at 1 d before surgery,and at 1 d after surgery(M1),4 d after surgery(M2),and 7 d after surgery(M3)was evaluated using the Montreal Cognitive Assessment Scale(MoCA).Enzyme-linked immunosorbent assay(ELISA)was used to detect serum cortisol and central nervous system specific protein(S-100β),and the intraoperative changes in rSO_(2)and postoperative neurological complications in each group were recorded.Results There was no statistically significant difference in interactions between groups,time points,and time points between groups in terms of Hb and Lac levels(P>0.05).There was no statistically significant difference in interactions between groups and time points in terms of PaCO_(2),rSO_(2),and pH(P>0.05).There was no statistically significant difference in interactions between groups and time points in terms of PaCO_(2)and pH(P>0.05).There was a statistically significant difference in interactions between groups and time points in terms of rSO_(2)(P<0.05).The MoCA scores of both groups decreased first and then increased with time,and there was a significant difference in the interaction between time points,and time points between groups(P<0.05),while there was no significant difference between groups(P>0.05).Both groups did not experience severe cerebral hypoxia during surgery.The incidence of mild and moderate cerebral hypoxia during surgery,as well as the incidence of postoperative delirium and POCD in the research group,were lower than those in the control group,and the difference was statistically significant(P<0.05).Before surgery,no significant difference was found in serum cortisol and S-100βin the two groups(P>0.05).After surgery,the levels of serum cortisol and S-100βwere higher than those before surgery,and S-100βlevel was higher in the research group than in the control group,showing a significant difference(P<0.05).There was no statistically significant difference in cortisol levels between two groups(P>0.05).Conclusion The use of NRIS monitoring technology combined with mechanical ventilation can significantly increase rSO_(2)in elderly colorectal patients undergoing radical resection for CRC,and effectively reduce the risks of cerebral hypoxia during the operation and postoperative neurological complications,which is conducive to reducing the early cognitive dysfunction after operation.