2023 年第 12 期 第 18 卷

术中吸入氧浓度对老年腰椎手术患者脑氧饱和度和术后短期认知功能的影响分析

Effects of inhaled oxygen concentrations on cerebral oxygen saturation and postoperative short-term cognitive function in elderly patients undergoing lumbar surgery

作者：叶雪飞姜小峰王臣雨曾睿峰刘华程

英文作者：Ye Xuefei Jiang Xiaofeng Wang Chenyu Zeng Ruifeng Liu Huacheng

单位：温州医科大学附属第二医院麻醉与围术期医学科，温州325000

英文单位：Department of Anesthesiology and Perioperative Medicine the Second Affiliated Hospital of Wenzhou Medical University Wenzhou 325000 China

关键词：术后认知功能障碍；吸入氧浓度；脊柱手术；腰椎手术；脑氧饱和度

英文关键词：Postoperativecognitivedysfunction;Inhaledoxygenconcentration;Spinesurgery;Lumbarsurgery;Cerebraloxygensaturation

• 摘要：

• 目的  探讨术中吸入氧浓度对老年腰椎手术患者脑氧饱和度和术后短期认知功能的影响。方法  选择2020年10月至2021年1月于温州医科大学附属第二医院择期行腰椎手术的老年患者45例。采用随机数字表法分为A、B、C 3组，每组15例。术中吸入氧浓度A、B、C 3组分别为30%、60%、80%。记录患者一般资料，比较各组不同时点生命体征、氧饱和度、疼痛视觉模拟量表评分、动脉血气分析结果及简易智力状态检查量表（MMSE）评分。结果  3组患者手术时间、麻醉时间差异均无统计学意义（均P>0.05）。3组患者脑氧饱和度在诱导前（T1）、手术结束前30 min（T2）、拔管后5 min（T3）3个时点差异均无统计学意义（均P>0.05）。3组术后即刻及术后1、3 d疼痛视觉模拟量表评分差异均无统计学意义（均P>0.05）。T2、T3 2个时点B组和C组动脉血氧分压高于A组、C组高于B组，差异均有统计学意义（均P<0.05）；而动脉血二氧化碳分压和动脉血乳酸水平在各时点组间差异均无统计学意义（均P>0.05）。3组不同时点MMSE评分差异均无统计学意义（均P>0.05）；3组术后1、3 d MMSE评分较本组术前1 d均有不同程度下降，术后3 d又较术后1 d有所上升，其中术后1 d MMSE评分与术前1 d比较差异均有统计学意义［（21.2±1.6）分比（23.2±1.6）分、（21.4±1.5）分比（23.1±1.8）分、（21.1±2.0）分比（23.0±1.7）分］（P<0.01或P<0.05）；分组和时间及其交互作用的方差分析结果显示分组和时间无交互效应（F=0.329，P=0.858）。结论  老年患者在经历腰椎手术后，短期内会出现一定程度的认知功能的损害。术中不同吸入浓度氧不会对患者脑氧饱和度和术后短期认知功能产生显著影响。

• Objective To explore the effects of inhaled oxygen concentrations on cerebral oxygen saturation and postoperative short-term cognitive function in elderly patients undergoing lumbar surgery. Methods Totally 45 elderly patients who underwent elective lumbar surgery in the Second Affiliated Hospital of Wenzhou Medical University from October 2020 to January 2021 were selected. They were divided into groups A, B, and C by the random number table method, with 15 cases in each group. The intraoperative inhalation oxygen concentrations in groups A, B, and C were 30%, 60% and 80%, respectively. The general information of patients was recorded, and the vital signs, oxygen saturation, pain visual analog scale scores, arterial blood gas analysis results, and Mini-Mental State Examination(MMSE) scores were compared at different time points in each group. Results  There were no statistically significant differences in surgical time and anesthesia time among the three groups (all P>0.05). There were no statistically significant differences in cerebral oxygen saturation among the three groups at three time points before induction(T1), 30 min before surgery(T2), and 5 min after extubation(T3)(all P>0.05). There were no statistically significant differences in the scores of the visual analog pain scale among the three groups immediately after surgery and on the first and third day after surgery(all P>0.05). The partial pressure of arterial oxygen in group B and group C was higher than that in group A, group C was higher than that in group B at T2 and T3(all P<0.05); however, there was no significant difference in arterial blood partial pressure of carbon dioxide and arterial blood lactate level among groups at each time point(all P>0.05). There was no significant difference in MMSE score among three groups at each time point(all P>0.05). The MMSE scores of the three groups decreased to varying degrees on the first and third day after surgery compared to the first day before surgery, and increased again on the third day after surgery compared to the first day after surgery; the MMSE scores on the first day after surgery showed statistically significant differences compared to the first day before surgery［(21.2±1.6) vs (23.2±1.6), (21.4±1.5) vs (23.1±1.8), (21.1±2.0) vs (23.0±1.7)］(P<0.01 or P<0.05). The analysis of variance of grouping and time and their interaction showed no interaction effect between grouping and time(F=0.329, P=0.858). Conclusions  After the lumbar surgery, elderly patients may suffer from cognitive impairment in the short-term. Different inhaled oxygen concentrations had no significant effect on cerebral oxygen saturation and postoperative short-term cognitive function.