Cheng Qinghao, Li Lei, Lin Duomao, Li Renjiao, Yue Yun, Wei Huafeng, Ma Jun
Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
China Meitan General Hospital, Beijing 100028, China.
J Thorac Dis. 2019 Mar;11(3):1065-1071. doi: 10.21037/jtd.2018.12.15.
There are multiple studies that have revealed that hypercapnia possessed neuroprotection, the conclusive cognitive impacts of permissive hypercapnia in medicine is still unclear.
A total of 102 patients registered for this research work had accomplished cognitive tests; with 64 patients possessing moderate hypercapnia all through bronchoscope intervention (BI). Thirty-six patients completed collection of blood specimens. Every patient underwent the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) a day before the surgery (T0), as well as at 7 days (T7). Serum specimens were used to measure levels of S100B, neuron-specific enolase (NSE), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA), superoxide dismutase (SOD) prior to the administration of anesthesia (T0), one day (T1) and seven days (T7) after surgery.
In comparison with the preoperative MMSE scores, Group Hypercapnia (Group H) on 7 days after surgery, exhibited a significant increased score (P=0.00). In comparison with the preoperative MoCA scores, Group H on 7 days after surgery exhibited a significant increased score (P=0.00). Meanwhile, the MoCA scores in Group H exhibited considerably higher elevation as compared with that in the Group Control (Group C) (P=0.01). No substantial differences were observed in serum S100B and NSE levels between Group H and Group C (P=0.23, P=0.14). Serum IL-6, TNF-α, SOD and MDA levels shared similarity between two groups.
Mild and moderate hypercapnia augmented cognitive activity with the help of MMSE tests and MoCA tests, whereby the latent reasons were not sure. As suggested by this study, hypercapnia up to 100 mmHg during BI was less likely to affect cognitive function adversely.
多项研究表明高碳酸血症具有神经保护作用，但允许性高碳酸血症在医学上的确切认知影响仍不清楚。
共有102名登记参与本研究工作的患者完成了认知测试；其中64名患者在整个支气管镜干预（BI）过程中存在中度高碳酸血症。36名患者完成了血液标本采集。每位患者在手术前一天（T0）以及术后7天（T7）接受简易精神状态检查表（MMSE）和蒙特利尔认知评估（MoCA）。在麻醉给药前（T0）、术后一天（T1）和术后七天（T7）采集血清标本，用于测量S100B、神经元特异性烯醇化酶（NSE）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、丙二醛（MDA）和超氧化物歧化酶（SOD）的水平。
与术前MMSE评分相比，高碳酸血症组（H组）术后7天的评分显著升高（P = 0.00）。与术前MoCA评分相比，H组术后7天的评分显著升高（P = 0.00）。同时，H组的MoCA评分升高幅度明显高于对照组（C组）（P = 0.01）。H组和C组之间血清S100B和NSE水平无显著差异（P = 0.23，P = 0.14）。两组血清IL-6、TNF-α、SOD和MDA水平相似。
轻度和中度高碳酸血症通过MMSE测试和MoCA测试增强了认知活动，但其潜在原因尚不确定。本研究表明，BI期间高达100 mmHg的高碳酸血症不太可能对认知功能产生不利影响。
