压力控制通气模式对老年脊柱结核患者术后谵妄的影响

王舜; 万海方; 倪燕华

doi:10.16766/j.cnki.issn.1674-4152.001956

压力控制通气模式对老年脊柱结核患者术后谵妄的影响

doi: 10.16766/j.cnki.issn.1674-4152.001956

1.
浙江大学医学院附属杭州市胸科医院麻醉科，浙江杭州 310003
2.
浙江大学医学院附属杭州市胸科医院老年病科，浙江杭州 310003

基金项目:

浙江省医药卫生科技计划项目 2019KY508

详细信息

通讯作者:
王舜, E-mail: doctorwang1983@163.com

中图分类号: R529.2 R614
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出版历程
- 收稿日期: 2020-05-08
- 网络出版日期: 2022-02-16

Effect of pressure controlled ventilation on postoperative delirium in elderly patients with spinal tuberculosis

1.
Department of Anesthesiology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003,China

摘要

摘要: 目的探讨压力控制通气(pressure controlled ventilation, PCV)模式对老年脊柱结核患者术后谵妄(postoperative delirium, POD)的影响。方法选择2018年9月—2019年9月浙江大学医学院附属杭州市胸科医院收治的72例老年脊柱结核患者，以随机数字表法分为观察组和对照组，各36例。观察组患者予以PCV模式通气[初始参数：V_T=8 mL/kg，氧流量=2 L/min，RR=12次/min，FiO₂=60%，I∶E=1∶1.5。术中保持FiO₂、I∶E不变，调整V_T为6 mg/kg+5 cm H₂O(1 cm H₂O=0.098 kPa)，并使PetCO₂保持在33~36 mm Hg水平(1 mm Hg=0.133 kPa)]，对照组患者予以常规正压通气(V_T=8 mL/kg，RR=12次/min，I∶E=1∶2，PEEP=0 cm H₂O)。于术后1周内以意识错乱评估方法(CAM)评估2组患者术后谵妄发生率，对于发生POD的患者予以对症治疗，均未出现因POD死亡病例，分析2组患者谵妄转归情况。结果观察组患者的POD发生率为19.44%(7/36)，低于对照组患者的41.67%(15/36)，χ²=4.189，P=0.041，而POD持续时间虽短于对照组患者，但差异无统计学意义(t=1.504，P=0.137)。观察组患者的POD转归情况好于对照组(Z=-2.799，P=0.005)，且观察组患者的转归率为100.00%(7/7)，优于对照组患者的53.33%(8/15)，χ²=4.791，P=0.029。结论老年脊柱结核患者术中行压力控制通气有助于减少术后谵妄的发生，并提高术后谵妄转归率，值得临床运用。
- 压力控制通气 /
- 脊柱结核 /
- 老年患者 /
- 术后谵妄 /
- 影响分析
Abstract: Objective To explore the effect of pressure-controlled ventilation (PCV) mode on postoperative delirium (POD) in elderly patients with spinal tuberculosis. Methods A total of 72 elderly patients suffering from spinal tuberculosis and admitted to a hospital from September 2018 to September 2019 were included in the study. They were randomly divided into observation and control groups with a simple random number table method, and each group contained 36 patients. Patients in the observation group received PCV mode ventilation [initial parameters: VT=8 mL/kg, oxygen flow=2 L/min, RR=12 times/min, FiO₂=60%, I∶E=1∶1.5. FiO₂; were maintained during the operation; I∶E was unchanged, VT was adjusted to 6 mg/kg+5 cm H₂O (1 cm H₂O=0.098 kPa) and PetCO₂ was maintained at 33-36 mm Hg (1 mm Hg=0.133 kPa) level). The control group received conventional positive pressure ventilation (V_T=8 mL/kg, RR=12 times/min, I∶E=1∶2, PEEP=0 cm H₂O). Within 1 week after surgery, the rate of postoperative delirium in both groups was evaluated with the consciousness confusion assessment method. For patients with POD after symptomatic treatment, no case of death due to POD was recorded, and the outcome of delirium in the two groups was analysed. Results The incidence rate of POD in the observation group was 19.44%(7/36), lower than that in the control group (41.67%, 15/36). The difference was statistically significant (χ²=4.189, P=0.041). POD continued despite that the time was shorter than that in the control group, and the difference was not statistically significant (t=1.504, P=0.137). The POD outcome of the observation group was better than that of the control group, and the difference was statistically significant (Z=-2.799, P=0.005). The outcome of the observation group was 100.00% (7/7), better than that of the control (53.33%, 8/15). Statistically significant differences were found (χ²=4.791, P=0.029). Conclusion Pressure control ventilation during the operation of elderly patients with spinal tuberculosis can help reduce the incidence of postoperative delirium and increase the postoperative delirium outcome rate and is thus suitable for clinical application.
- Pressure controlled ventilation /
- Spinal tuberculosis /
- Elderly patients /
- Postoperative delirium /
- Impact analysis

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表 1 2组老年脊柱结核患者的基线资料比较[例(%)]

组别	例数	性别(男/女，例)		年龄(x ±s，岁)	病程(x ±s，月)		BMI(x ±s)	手术时间(x ±s，h)	术中出血量(x ±s，mL)
观察组	36	23/13		78.60±6.65	4.62±0.58		22.96±2.17	3.22±0.68	197.65±27.92
对照组	36	21/15		78.66±6.68	4.68±0.64		22.37±1.96	3.31±0.57	203.39±26.02
统计量		0.234^a		0.038^b	0.417^b		1.211^b	0.609^b	0.902^b
P值		0.629		0.970	0.678		0.230	0.545	0.370

组别	例数	手术部位			基础疾病			术中低氧血压
组别	例数	颈椎	胸椎	腰椎	冠心病	高血压	糖尿病	是	否
观察组	36	4(11.11)	9(25.00)	23(63.89)	5(13.89)	5(13.89)	6(16.67)	13(36.11)	23(63.89)
对照组	36	3(8.33)	7(19.44)	26(72.22)	6(16.67)	7(19.44)	8(22.22)	16(44.44)	20(55.56)
统计量		0.158^a	0.321^a	0.575^a	0.107^a	0.400^a	0.355^a	0.520^a
P值		0.691	0.571	0.448	0.743	0.527	0.551	0.471
注：^a为χ²值，^b为t值。

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表 2 2组老年脊柱结核患者的POD发生情况比较[例(%)]

组别	例数	术后1 d	术后3 d	术后5 d	术后7 d
观察组	36	0(0.00)	2(5.56)	5(13.89)	7(19.44)
对照组	36	2(5.56)	7(19.44)	12(33.33)	15(41.67)
χ²值		2.057	3.175	3.773	4.189
P值		0.151	0.075	0.052	0.041

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表 3 广义估计方程检验结果

参数	B	SE	Wald χ²	P值	95% CI
(截距)	0.282	0.334	0.715	0.398	-0.372~0.937
[组别=1.00]	1.226	0.540	5.163	0.023	0.169~2.284
[时点=1.00]	2.829	0.686	16.997	< 0.001	1.484~4.174
[时点=2.00]	1.189	0.306	5.064	< 0.001	0.588~1.789
[时点=3.00]	0.378	0.164	5.353	0.021	0.058~0.699
(标度)	1.000
注：(1)组间比较显示Wald χ²＝5.163，P＝0.023，组间差异具有统计学意义。与对照组比较观察组概率为0.023，OR值为0.293。(2)重复测量时间比较结果：Wald χ²＝23.957，P < 0.001，时点差异有统计学意义，不同通气方式患者不同时点POD发生情况差异有统计学意义。与术后7 d比较术后1 d、术后3 d、术后5 d概率分别为 < 0.001、 < 0.001、0.021，OR值分别为16.929、8.926、1.459。

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表 4 2组老年脊柱结核患者的POD转归情况比较[例(%)]

组别	例数	痊愈	好转	无效	转归率
观察组	7	4(57.14)	3(42.86)	0(0.00)	7(100.00)
对照组	15	6(40.00)	2(13.33)	7(46.67)	8(53.33)
统计量			-2.799^a		4.791^b
P值			0.005		0.029
注：^a为Z值，^b为χ²值。

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