马琨 米梅艳 马朋羽

[摘要] 目的 探討围术期体温保护对老年胃肠手术患者脑氧代谢及氧化应激的影响。 方法 回顾性分析2016年1月～2017年11月石家庄市第四医院收治的行胃肠手术的105例老年患者的临床资料，将其中采用围术期常规处理的设为常规组（51例），采用围术期常规+保温处理的设为研究组（54例）。比较麻醉前（T1）、手术开始后15 min（T2）、手术结束即刻（T3）及术后2 h（T4）的体温（Temp）、心率（HR）与平均动脉压（MAP）；对比颈内静脉内血氧分压（PjvO2）、颈内静脉血氧饱和度（SjvO2）、颈内静脉血氧含量（CjvO2）、颈静脉血乳酸（JVL）及血清丙二醛（MDA）、超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）水平；观察寒颤、烦躁发生情况及术后苏醒时间。 结果 研究组Temp、HR及MAP各数值均无明显波动（P > 0.05），常规组T2、T3、T4时点均明显低于T1时点（P < 0.05），常规组T3、T4时点均明显低于T2（P < 0.05）；除T1外，研究组Temp均明显高于常规组（P < 0.05），HR与MAP均明显低于常规组（P < 0.05）；除T1外，研究组PjvO2、SjvO2、CjvO2、SOD及GSH-Px均明显高于常规组（P < 0.05），JVL及MDA均明显低于常规组（P < 0.05）；研究组寒颤及烦躁发生率均明显低于常规组（P < 0.01），术后苏醒时间明显短于常规组（P < 0.01）。 结论 围术期体温保护有利于维持老年胃肠手术患者的生命体征稳定，可明显改善脑氧代谢及氧化应激反应，并可减少寒颤及烦躁的发生，缩短患者苏醒时间。

[关键词] 围术期体温保护；胃肠手术；脑氧代谢；氧化应激

[中图分类号] R735 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0091-05

[Abstract] Objective To investigate the influences of perioperative temperature protection on brain oxygen metabolism and oxidative stress in the elderly patients with gastrointestinal surgery. Methods The clinical case data of 105 cases of elderly patients with gastrointestinal surgery from January 2016 to November 2017 in the Fourth Hospital of Shijiazhuang were retrospectively analyzed， including of routine perioperative treatment as routine group （51 cases） and routine perioperative + heat treatment as study group （54 cases）. The body temperature （Temp）， heart rate （HR） and mean arterial pressure （MAP） were compared before anesthesia （T1）， after 15 mins of operation （T2）， immediately after operation （T3） and 2 h after operation （T4）， as well as the blood oxygen partial pressure （PjvO2）， blood oxygen saturation （SjvO2）， blood oxygen content （CjvO2） and lactate in jugular vein blood （JVL） and serum levels of malondialdehyde （MDA）， superoxide dismutase （SOD） and glutathione peroxidase （GSH-Px）， and the occurrence of chills and irritability and postoperative recovery time were observed. Results The values of Temp， HR and MAP of the study group had no obvious fluctuation （P > 0.05）， of which the routine group at T2， T3 and T4 were significantly lower than those at T1 （P < 0.05）， of which the routine group at T3 and T4 were significantly lower than those at T2 （P < 0.05）. Except T1， the Temp of the study group were significantly higher than those of the routine group （P < 0.05）， and the HR and MAP of the study group were significantly lower than those of the routine group （P < 0.05）. Except T1， the PjvO2， SjvO2， CjvO2， SOD and GSH-Px of the study group were significantly higher than those of the routine group （P < 0.05）， and the JVL and MDA of the study group were significantly lower than those of the routine group （P < 0.05）. The incidence rates of chills and irritability of the study group were significantly lower than those of the routine group （P < 0.01）， and the recovery time after operation of the study group was significantly shorter than that of the routine group （P < 0.01）. Conclusion Perioperative temperature protection can maintain the stability of the life signs of the elderly patients with gastrointestinal surgery， obviously improve the brain oxygen metabolism and oxidative stress response， reduce the occurrence of chills and irritability and shorten the recovery time.

[Key words] Perioperative temperature protection； Gastrointestinal surgery； Cerebral oxygen metabolism； Oxidative stress

近年来，我国老年人胃肠道病变发生率逐渐升高，手术率也随之提高[1]。胃肠手术过程中，患者可能会出现体温明显下降，甚至寒颤[2]。有研究表明[3]，亚低温可降低脑氧耗及乳酸含量，并可抑制内源性毒性物质释放，对脑有明显保护作用。当体温显著降低时，则可使脑供血不足、诱发心律失常等[4]。本研究回顾性分析老年胃肠手术患者的临床病例资料，探讨围术期体温保护对老年胃肠手术患者生命体征、脑氧代谢及氧化应激的影响，并与常规处理对照，以期为临床提供参考，具体报道如下：

1 资料与方法

1.1一般资料

回顾性分析2016年1月～2017年11月石家庄第四医院收治的行胃肠手术的105例老年患者的临床资料，其中51例实施围术期常规处理（常规组），54例实施围术期常规+保温处理（研究组）。常……