气管插管对不同年龄患者高位颈内静脉血氧饱和度的影响<sup>*</sup>

doi:10.3969/j.issn.1671-7171.2021.04.027

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摘要 【目的】 探讨气管插管对不同年龄患者脑血流、脑氧平衡的影响。【方法】 70例ASA分级Ⅰ～Ⅱ级的择期手术患者按年龄分组为老年组(观察组,年龄≥65岁,n=28)与年轻组(对照组,n=42)。在入室后(T₀)、气管插管后3 min(T₁)、10 min(T₂)、20 min(T₃)以及手术开始后20 min(T₄)、术毕拔管后20 min(T₅)在超声引导下于下颌角平面颈内静脉穿刺采集血液进行血气分析,对比两组高位颈内静脉血氧分压(upPvO₂)、高位颈内静脉血氧饱和度(upSvO₂)、高位颈内静脉血二氧化碳分压(upPvCO₂)以及高位颈内静脉血乳酸(upvLac)和血糖(Gluv)改变。【结果】 在T₀～T₅时两组患者upPvO₂、upSvO₂改变趋势一致,表现为气管插管后先升后降、术中再度上升的趋势;与对照组比较,观察组T₁～T₃时upPvO₂、upSvO₂升高,T₂～T₄时upPvCO₂升高,其差异均有统计学意义(P<0.05)。在T₀～T₅时两组患者upvLac均持续下降,与观察组比较,T₅时对照组upvLac下降 ;而T₀～T₅时,观察组Gluv高于对照组,其差异均有统计学意义(P<0.05)。【结论】 老年患者气管插管后upPvO₂、upSvO₂峰值升高反映了脑血流的快速增加和脑的过度灌注,与老年患者脑血管自动调节功能受损有关;老年患者麻醉诱导期维持血流动力学的稳定尤其重要。

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关键词 ：插管法,气管内, 年龄分布, 血氧测定法, 颈静脉/解剖学和组织学

Abstract：【Objective】 To investigate the effect of endotracheal intubation on cerebral blood flow and cerebral oxygen balance in patients of different ages. 【Methods】 Seventy ASAⅠ-Ⅱpatients were divided into young group (Y group,n42) and old group (O group,n28), The up-internal jugular vein puncture was performed under the guidance of ultrasound at the time of entering the operation groom (T₀), 3 min (T₁)、 10 min (T₂)、 20 min (T₃) after tracheal intubation, 20 min (T₄) after operation and 20 min (T₅) after extubation. The up-internal jugular vein oxygen partial pressure (upPvO₂)、 up-internal jugular vein oxygen saturation (upSvO₂)、 up-internal jugular vein carbon dioxide partial pressure (upPvCO₂)、 up-internal jugular vein lactic acid (upvLac) and up-internal jugular vein glucose (Gluv) were compared. 【Results】 From T₀ to T₅, the changes of upPvO₂ and upSvO₂ in the two groups were consistent, After intubation, it was increased fast and then decreased and increased again during operation. Compared with group Y, upPvO₂ and upSvO₂ increased significantly at T₁-T₃ in group O (P<0.05), and upPvCO₂ increased significantly at T₂-T₄ in group O (P<0.05). From T₀ to T₅, upvLac decreased continuously in both groups, Compared with group O, upvLac in group Y decreased significantly at T₅ (P<0.05);At T₀-T₅, the Gluv of group O was higher than that of group Y (P<0.01). 【Conclusion】 The peak value of upPvO₂ and upSvO₂ after tracheal intubation in elderly patients reflects the rapid increase of cerebral blood flow and cerebral hyperperfusion, which is related to the impairment of cerebrovascular autoregulation in elderly patients。It is particularly important to maintain hemodynamic stability in elderly patients during anesthesia induction.

Key words： Intubation, Intratracheal Age Distribution Oximetry Jugular Veins/AH

收稿日期: 2021-01-25

中图分类号:

R605.973

基金资助:* 2019年昆山市重点研发计划(KS1954)

引用本文:

费建平, 赵赢, 晋维林, 雷月, 王欢锋, 包华芳, 袁春英. 气管插管对不同年龄患者高位颈内静脉血氧饱和度的影响^*[J]. 医学临床研究, 2021, 38(4): 572-575.
FEI Jian-ping, ZHAO Ying, JIN Wei-lin, et al. Effect of Endotracheal Intubation on Oxygen Saturation of Up-Internal Jugular Vein in Patients of Different Ages. JOURNAL OF CLINICAL RESEARCH, 2021, 38(4): 572-575.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2021.04.027 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2021/V38/I4/572

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