本文關(guān)鍵詞：機(jī)器人輔助手術(shù)Trendelenburg體位對(duì)老年患者腦功能的影響及相應(yīng)腦保護(hù)的研究　出處：《中國(guó)人民解放軍醫(yī)學(xué)院》2015年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 機(jī)器人手術(shù)系統(tǒng) Trendelenburg體位 腦功能 神經(jīng)保護(hù)

【摘要】：目的：探討機(jī)器人輔助腹腔鏡手術(shù)Trandelenbureg(頭低+腳高+截石位)傾斜40°體位對(duì)老年患者腦功能的影響和相應(yīng)腦保護(hù)的研究。方法：1.回顧20例膀胱癌根治手術(shù)的臨床資料,比較10例全機(jī)器人膀胱切除+原位回腸代膀胱手術(shù)與10例腹腔鏡膀胱切除+開放回腸代膀胱手術(shù)后的蘇醒時(shí)間,并探討發(fā)生術(shù)后蘇醒延長(zhǎng)的危險(xiǎn)因素。2.80例擇期行機(jī)器人手術(shù)的患者按年齡分兩組：老年組65-80歲,中年組45-64歲,每組40例。兩組患者分別于氣腹前(T0)、氣腹后15min(T1)、 Trendelenberg體位后15min(T2)、Trendelenberg體位后60min(T3)、停氣腹后15min(T4)抽取所有患者頸靜脈球血和橈動(dòng)脈血進(jìn)行血?dú)夥治?并且比較上述各時(shí)刻：a.腦氧飽和度b.頸靜脈球氧飽和度c.頸靜脈球壓力d.腦動(dòng)靜脈氧含量差e.頸內(nèi)靜脈血糖和乳酸的變化。3.擇期行機(jī)器人手術(shù)的患者80例,隨機(jī)雙盲分為對(duì)照組和右美托咪啶組,每組40例。右美托咪啶組將右美托咪啶以0.8Hg/(kg·h)靜脈泵注10 min,再以0.3μg/(kg·h)恒速維持至手術(shù)結(jié)束前30 min；對(duì)照組給予生理鹽水。氣腹建立后,所有患者采用頭低40°Trendelenberg體位。術(shù)后進(jìn)行Ramsay鎮(zhèn)靜評(píng)分、Riker鎮(zhèn)靜和躁動(dòng)評(píng)分、舒適度評(píng)分和VAS評(píng)分；在術(shù)前1d,術(shù)后第1天,術(shù)后第5天認(rèn)知功能測(cè)試及比較神經(jīng)元特異性烯醇化酶(NSE)、血清腫瘤壞死因子-α(TNF-α)、超氧化物歧化酶(SOD)和白細(xì)胞介素-6(IL-6)的含量。結(jié)果：1.手術(shù)后蘇醒延遲危險(xiǎn)因素的logistic單因素分析結(jié)果顯示Ppeak(P=0.0001)、BE(P=0.0002)、 PaCO2(P=0.005)、 PetCO2(P=0.02)、頭低位時(shí)間(P=0.01)是機(jī)器人手術(shù)后發(fā)生蘇醒延遲的危險(xiǎn)因素。2.與基礎(chǔ)值氣腹前(T0)比較,兩組患者在氣腹+頭低位各時(shí)刻腦氧飽和度、頸靜脈球氧飽和度、頸靜脈球壓力升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；腦動(dòng)靜脈氧含量差顯著性減少,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；與中年組組比較,老年組在Trendelenberg體位后15min(T2)、Trendelenber g體位后60min(T3)時(shí)刻腦氧飽和度、頸內(nèi)靜脈血氧飽和度、頸靜脈球壓力顯著升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05),腦動(dòng)靜脈氧含量差顯著降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；3.與對(duì)照組比較,右美托咪啶組患者術(shù)后Ramsay鎮(zhèn)靜評(píng)分升高(P0.05); Riker鎮(zhèn)靜和躁動(dòng)評(píng)分降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；術(shù)后1d對(duì)照組17人,右美托咪啶組11人,術(shù)后5d對(duì)照組12人,右美托咪啶組9人發(fā)生POCD；在術(shù)后1d和術(shù)后5d右美托咪啶組血清TNF-a, NSE, IL-6較對(duì)照組明顯降低(P0.05),右美托咪啶組血清SOD較對(duì)照組明顯升高(P0.05)。結(jié)論：氣腹及Trendelenburg體位引起腦靜脈回流阻力升高、腦血流增加,延長(zhǎng)術(shù)后蘇醒時(shí)間。右美托咪啶能提高老年患者在機(jī)器人輔助手術(shù)麻醉蘇醒期鎮(zhèn)靜評(píng)分、降低蘇醒期躁動(dòng)評(píng)分并改善術(shù)后認(rèn)知功能,對(duì)中樞神經(jīng)系統(tǒng)有一定保護(hù)作用,其作用機(jī)制可能與右美托咪啶能減輕炎癥反應(yīng)和消除氧自由基有關(guān)。
[Abstract]:Objective: To investigate the effects of robot assisted laparoscopic surgery (Trandelenbureg + high + low pin lithotomy position) on the inclination of 40 degrees influence position on brain function in elderly patients and the corresponding brain protection. Methods: 1. review the clinical data of 20 cases of radical resection of bladder cancer, compared with 10 cases of total robot cystectomy with orthotopic ileal neobladder and 10 cases of laparoscopic cystectomy + open ileal neobladder surgery recovery time, postoperative recovery and to explore the extension of the risk factors of.2.80 patients undergoing robotic surgery were divided into two groups according to age: 65-80 years old group, middle age group 45-64 years, 40 cases in each group. The patients in these two groups before pneumoperitoneum (T0), 15min after pneumoperitoneum (T1), Trendelenberg 15min (T2) after position after position, Trendelenberg 60min (T3), 15min after the end of pneumoperitoneum (T4) collected from all patients of jugular venous and radial artery blood gas analysis, and compare the 鍒伙細(xì)a.鑴戞哀楗卞拰搴.棰堥潤(rùn)鑴夌悆姘чケ鍜屽害c.棰堥潤(rùn)鑴夌悆鍘嬪姏d.鑴戝姩闈?rùn)鑴夋哀鍚噺宸甧.棰堝唴闈?rùn)鑴夎。?

本文編號(hào)：1431025