术中调控PaCO2对OPCAB患者术后认知功能的影响

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。

Effect of PaCO2 Modulating During Operation on Post-Operative Cognitive Function of Patients Undergoing OPCAB

Objective To observe the effect of PaCO_2 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 (G_ 1 , n=15) and modulated group (G_ 2 , n=15). During operation, PaCO_ 2 in G_ 1 maintained 35 mmHg to 39 mmHg with relatively fixed ventilation parameters setting, and PaCO_ 2 in G_ 2 ranged from 40 mmHg to 45 mmHg by adjusting ventilation parameters. Continuous cardiac output index (CCI), SvO_ 2 , regional cerebral O_ 2 saturation (rSO_ 2 ) and PaCO_ 2 were recorded before distal anastomosis(T_ 1 ), at 5 min of the first distal vessel anastomosis(T_ 2 ), second distal vessel anastomosis(T_ 3 ) and third distal vessel anastomosis(T_ 4 ), 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 G_ 1 was obviously lower than that of pre-HDS-R (P< 0.05), while there was no such difference in G_ 2 . rSO_ 2 of the two groups at time point T_ 1 ,T_ 2 , T_ 3 , T_ 4 and_ T_ 5 in G_ 2 was significantly higher than that in G_ 1 (P<0.05 or P<0.01), while rSO_ 2 at T_ 2, T_ 3, T_ 4 and T_ 5 in each group all declined significantly (P<0.05 or P<0.01). Conclusion It suggests that rSO_ 2 can be elevated with PaCO_2 during operation, and therefore may improve the post-operative cognitive function of patients undergoing OPCAB.