脑氧饱和度变化对女性腔镜手术术后恶心呕吐的影响

发布时间：2018-03-18 21:55

本文选题：妇科腹腔镜手术　切入点：脑氧饱和度　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察围术期大脑血氧饱和度(Cerebral oxygen saturation,SCTO2)变化对女性腔镜手术术后恶心呕吐(Postoperative nausea and vomiting,PONV)的影响,并探讨女性腔镜手术术后发生恶心呕吐的机制。方法:选取择期全身麻醉方式患者120例:妇科腔镜手术60例、妇科开腹手术30例和女性腔镜胆囊手术30例,分为A、B、C、D四组,A组:妇科腔镜手术30例;B组:妇科开腹手术30例;C组:妇科腔镜手术30例,手术开始前以0.5g/kg剂量快速静脉滴注20%甘露醇;D组:女性腔镜胆囊手术30例。分别在T1:入室5min、T2:插喉罩后5min、T3:建立气腹、体位变化即刻、T4:建立气腹后15min、T5:排气体位变化即刻、T6:排气后10min这六个时间点观测四组患者围术期SCTO2、平均椎动脉血流速度(Vertebral artery average blood flow velocity,VM)和椎动脉血管阻力(vertebral artery vascular resistance,RI)变化以及术后48h内患者PONV的发生率。结果:在围术期,所有患者脑氧饱和度都缓慢上升,在T4、T5两个时间点,B、C、D三组术中SCTO2低于A组,有统计学意义(P0.05);C组术中VM高于A组,有统计学意义(P0.05)。T5时间点,D组术中VM显著高于于A组,有统计学意义(P0.05)。T4时间点,D组RI低于其余三组,有统计学意义(P0.05)。术后24h内,B、C、D三组发生恶心呕吐例数均小于A组,有统计学意义(P0.05);且C组发生恶心呕吐例数明显低于B、D两组,有统计学差异(P0.05)。术后48h内,B、C、D三组恶心呕吐发生率明显低于A组,有统计学意义(P0.05);B、C、D三组间无明显统计学差异(P0.05)。结论:女性腔镜手术术中患者颅内压升高使大脑氧耗减少,可导致SCTO2升高。围术期,脑氧饱和度升高和颈椎动脉平均血流速度减少,都可以增加女性腔镜手术PONV的发生率。
[Abstract]:Objective: to observe the effect of changes of cerebral oxygen saturation during perioperative period on postoperative nausea and vomiting PONV2 in female patients undergoing endoscopic surgery. Methods: 120 patients with elective general anesthesia were selected, including 60 gynecological endoscopic surgery, 30 gynecologic laparotomy and 30 female endoscopic cholecystectomy. The patients were divided into four groups: group A: gynecological endoscopic surgery (group B): gynecologic laparotomy group (group C): gynecological endoscopic surgery (group C), gynecological endoscopic surgery (group A, n = 30). Before operation, 20% mannitol intravenously injected with 0.5 g / kg was given to 20% mannitol group D: 30 cases of female cholecystectomy were performed by endoscopic cholecystectomy, respectively at T1: 5 min after laryngeal mask insertion, 5 min after larynx mask, and 5 min after insertion of larynx mask: to establish pneumoperitoneum, and to establish pneumoperitoneum. Immediate postural change: 15 min after establishment of pneumoperitoneum, T5: change of ventral position: change of ventral position immediately and T6: observation of perioperative SCTO2, mean vertebral artery artery average blood flow velocityVMs and vertebral artery vascular resistance (vertebral artery vascular resistance RI) in four groups of patients during perioperative period (SCTO2, mean vertebral artery flow velocity (VMV)) and vertebral artery resistance (vertebral artery vascular resistance) (RI) were observed at six time points after pneumoperitoneum (Pneumoperitoneum pneumoperitoneum). Results: during the perioperative period, the incidence of PONV was observed within 48 hours after operation. The cerebral oxygen saturation increased slowly in all the patients. The SCTO2 in group D was lower than that in group A at two time points of T4 and T5, and the intraoperative VM in group C was significantly higher than that in group A, and the VM in group D was significantly higher than that in group A. The RI of group D was significantly lower than that of the other three groups, and the number of nausea and vomiting in group D was lower than that in group A within 24 hours after operation, and the number of cases of nausea and vomiting in group C was significantly lower than that in group BD, and the incidence of nausea and vomiting in group C was significantly lower than that in group B (P < 0.05), and the incidence of nausea and vomiting in group C was significantly lower than that in group B (P < 0.05). The incidence of nausea and vomiting in group D was significantly lower than that in group A within 48 hours after operation, and there was no significant difference among the three groups. Conclusion: the increase of intracranial pressure in female patients during endoscopic surgery reduces cerebral oxygen consumption. During perioperative period, increased cerebral oxygen saturation and decreased mean blood flow velocity of cervical artery increased the incidence of PONV in female endoscopic surgery.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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