[1]王静玉,符聪,荀玉月,等.不同体温管理策略对老年单肺通气患者脑氧饱和度变化率和术后谵妄的影响[J].军事护理,2021,38(08):27-30.[doi:10.3969/j.issn.1008-9993.2021.08.008]
　WANG Jingyu,FU Cong,XUN Yuyue,et al.Effects of Different Body Temperature Management Strategies on Cerebral Oxygen Saturation Change Rate and Postoperative Delirium among Elderly Patients with One-lung Ventilation[J].Nursing Journal Of Chinese People's Laberation Army,2021,38(08):27-30.[doi:10.3969/j.issn.1008-9993.2021.08.008]
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不同体温管理策略对老年单肺通气患者脑氧饱和度变化率和术后谵妄的影响
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《军事护理》[ISSN:2097-1826/CN:31-3186/R]

卷:
38
期数:
2021年08期
页码:
27-30
栏目:
论著
出版日期:
2021-08-15

文章信息/Info

Title:
Effects of Different Body Temperature Management Strategies on Cerebral Oxygen Saturation Change Rate and Postoperative Delirium among Elderly Patients with One-lung Ventilation
文章编号:
1008-9993(2021)08-0027-05
作者:
王静玉; 符聪; 荀玉月; 邓曙雨; 方平
(浙江省宁波市医疗中心李惠利医院 麻醉手术中心,浙江 宁波 315000)
Author(s):
WANG Jingyu; FU Cong; XUN Yuyue; DENG Shuyu; FANG Ping
(Anesthesia and Operation Center,Li Huili Hospital,Ningbo Medical Center,Ningbo 315000,Zhejiang Province,China)
关键词:
体温;  老年;  脑氧饱和度;  术后谵妄;  单肺通气
Keywords:
body temperature;  elderly;  cerebral oxygen saturation;  postoperative delirium;  one-lung ventilation
分类号:
R472.3
DOI:
10.3969/j.issn.1008-9993.2021.08.008
文献标志码:
A
摘要:
目的 探讨不同体温管理策略对老年单肺通气患者脑氧饱和度(regional saturation of cerebral oxygenation,rScO2)变化率和术后谵妄(postoperative delirium,POD)的影响。方法 2019年4月至2020年4月,便利抽样法选取宁波市某三级甲等医院行胸腔镜下肺叶切除术的96例老年患者为研究对象,根据随机数字表法,将患者分为中档组(M组)、综合组(Z组)和高档组(H组),各32例。三组患者在常规保温基础上实施不同的体温管理策略。比较三组入室(T0)、麻醉后(T1)、单肺通气30 min(T2)、60 min(T3)、90 min(T4)、手术结束(T5)的生命体征、rScO2变化率及苏醒期躁动发生率、视觉模拟(visual analogue scale,VAS)评分和POD的发生率。 结果 三组体温随时间延长逐渐下降,T2～T5的体温Z组和H组均高于M组(均P<0.05)。三组单肺通气后rScO2呈下降趋势至术毕接近基线水平,T3～T4的rScO2值由高到低,依次为Z、H、M组(均P<0.05)。三组rScO2变化率、POD例数及苏醒期躁动发生率由高到低分别为M、H、Z组(均P<0.05)。患者体温变化率、rScO2变化率与POD三者之间行相关性分析均呈正相关。结论 充气式保温毯设为43℃ 1 h后改为38℃的体温管理策略可有效降低rScO2变化率和POD发生率。
Abstract:
Objective To investigate the effects of different body temperature management strategies on cerebral oxygen saturation change rate and postoperative delirium(POD)among elderly patients with one-lung ventilation.Methods A total of 96 patients with thoracoscopic lobectomy were selected and divided into medium(M)group,comprehensive(Z)group and high-grade(H)group.The vital signs,regional saturation of cerebral oxygenation(rScO2),incidence of agitation during recovery period,visual analogue scale(VAS)score and incidence of POD were compared among the three groups after entering the operation room(T0),after anesthesia(T1),one-lung ventilation for 30min(T2),60min(T3),90min(T4),and at the end of operation(T5).Results In the three groups,patients' body temperature decreased gradually with the extension of time.Patients' body temperature at T2 to T5 in the Group Z and Group H were higher than those in the Group M(all P<0.05).After one-lung ventilation,the rScO2 in the three groups showed a downward trend and approached the baseline level at the end of operation.The order from the highest rScO2 to the lowest rScO2 at T3 and T4 was the Group Z,the Group H,and the Group M(all P<0.05). The order of the change rate of body temperature and rScO2,the incidence of POD and the incidence of agitation during recovery period was the Group M,the Group H,and the Group Z(from the highest to the lowest)(all P<0.05).There were positive correlations among the change rate of body temperature,the change rate of rScO2 and the incidence of POD.Conclusions The change rate of rScO2 and the incidence of POD can be effectively reduced when the temperature of inflatable insulation blanket is changed to 38℃ after being set at 43℃ for one hour.

参考文献/References:

[1] ROBERTS M L,LIN H M,TINUOYE E,et al.The association of cerebral desaturation during one-lung ventilation and postoperative recovery: a prospective observational cohort study[J].J Cardiothorac Vasc Anesth,2021,35(2):542-550.
[2] DAHL R H,TAUDORF S,BAILEY D M,et al.A method for modelling the oxyhaemoglobin dissociation curve at the level of the cerebral capillary in humans[J].Exp Physiol,2020,105(7):1063-1070.
[3] 方平,王静玉,符聪.保温温度对老年肝癌患者体温及麻醉恢复的影响[J].肝胆胰外科杂志,2020,32(7):415-419.
[4] FOLSTEIN M F,FOLSTEIN S E,MCHUGH P R.“Mini-mental state”.A practical method for grading the cognitive state of patients for the clinician[J].J Psychiatr Res,1975,12(3):189-198.
[5] 贾雪松,谢淑华,魏颖,等.老年患者腹腔镜术中rScO2变化率与术后早期认知功能的关系[J].中华麻醉学杂志,2019,39(4):408-410.
[6] 李娟,邹义壮,冯锋田,等. 谵妄评定方法修订及其信度、效度测试[J].临床精神医学杂志,2003,13(3):147-149.
[7] RIKER R R,PICARD J T,FRASER G L.Prospective evaluation of the sedation-agitation scale for adult critically ill patients[J].Crit Care Med,1999,27(7):1325-1329.
[8] 曹卉娟,邢建民,刘建平.视觉模拟评分法在症状类结局评价测量中的应用[J].中医杂志,2009,50(7):600-602.
[9] 唐成菊,刘亚,张臣艳.充气式加温毯对老年胃癌根治术患者术后体温及炎症因子的影响[J].解放军护理杂志,2019,36(5):51-53.
[10] SESSLER D I,SCHROEDER M,MERRIFIELD B,et al.Optimal duration and temperature of prewarming[J].Anesthesiology,1995,82(3):674-681.
[11]ZHOU Y,LI Y,WANG K. Bispectral index monitoring during anesthesia promotes early postoperative recovery of cognitive function and reduces acute delirium in elderly patients with colon carcinoma:a prospective controlled study using the attention network test[J].Med Sci Monit,2018,31(24):7785-7793.
[12]EERTMANS W,DE DEYNE C,GENBRUGGE C,et al.Association between postoperative delirium and postoperative cerebral oxygen desaturation in older patients after cardiac surgery[J].Br J Anaesth,2020,124(2):146-153.
[13]KAWANO T, YAMANAKA D, AOYAMA B, et al. Involvement of acute neuroinflammation in postoperative delirium-like cognitive deficits in rats[J].J Anesth,2018,32(4):506-517.
(本文编辑:王园园)

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备注/Memo

备注/Memo:
【 收稿日期 】 2021-04-08 【 修回日期 】 2021-07-07
【 基金项目 】 浙江省医药卫生科技计划(2021KY310); 宁波市医学科技计划项目(2017A56)
【 作者简介 】 王静玉,本科,副主任护师,从事手术室护理工作
【 通信作者 】 方平,电话:0574-87018727
更新日期/Last Update: 2021-08-15