神经外科手术中患者体温与脑氧代谢的变化及其相关性分析

发布时间：2018-08-08 18:48

【摘要】：目的： 观察择期神经外科手术患者在我院手术室条件下其体温与脑氧代谢的变化,探讨两者之间的相关性,为神经外科手术术中是否采用低温进行脑保护提供依据。 方法： 收集择期行颅内占位手术患者20例,入手术室后常规保温,监测BP、HR、ECG、SPO2。麻醉诱导气管内插管后,经桡动脉置入动脉测压管；经右侧颈内静脉逆行置入双腔静脉导管,确保前端位于颈静脉窦部(第二颈椎至颅骨之间)；经鼻腔置入鼻咽温探头至咽腔部。于气管插管后即刻(t1)、硬脑膜切开时(t2)、取瘤1小时(t3)、硬脑膜缝合时(t4)、拔管后10分钟(t5),记录其体温并同步采取桡动脉及颈内静脉球部血液作血气分析：记录二者血氧分压、氧饱和度、血红蛋白含量等,依据FICK公式计算颈内动脉、颈内静脉血氧含量及差值、脑氧摄取率。 结果： 1.20例患者在术中均有颈静脉球部血氧饱和度上升、颈内动静脉血氧含量差及脑氧摄取率下降的情况出现,而其中有18例在术中出现了体温下降(34.7℃≤体温35.9℃)的现象。 2.体温方面：与t1比较,t2、t3、t4体温明显下降；与t3及t4相比,t5的体温有明显上升。(P0.05) 3.脑氧代谢相关指标颈静脉球部血氧饱和度：在t3、t4时较t1时明显升高,在t5时又较t4时明显下降。颈内动静脉氧含量差方面：与t1相比,t2、t3、t4、t5均减少有统计学差异；与t2相比,t4的减少程度也有统计学差异；与t4相比,t5开始回升有统计学差异。脑氧摄取率方面：与t1及t2相比,t4明显下降；而t3与t1相比也有统计学差异；与t4相比,t5开始上升并有统计学意义。(P0.05) 4.体温与颈静脉球部血氧饱和度相关性显示：r=-0.300,p=0.002。体温与颈内动静脉氧含量差相关性显示：r=0.341,p=0.001；体温与脑氧摄取率相关性分析显示r=0.317,p=0.001,表明体温与脑氧代谢呈线性相关。(P0.01) 结论： 在我院层流手术室条件下开展的神经外科择期开颅手术中,无需对患者采用特别的降温措施,患者的体温可出现一定程度的下降,下降幅度安全,无不良反应,其脑氧代谢也可因手术过程及麻醉所致的低温及其它如麻醉药物等的影响而出现一定的下降,从而使脑组织得到一定的保护。
[Abstract]:Objective: to observe the changes of body temperature and cerebral oxygen metabolism in patients undergoing elective neurosurgery in our hospital, and to explore the correlation between them, and to provide evidence for brain protection by hypothermia during neurosurgery. Methods: twenty patients with selective intracranial space occupying operation were collected, and routine thermal insulation was performed after entering the operating room to monitor BPH-HRG and SPO _ 2. After endotracheal intubation induced by anesthesia, arterial barometric tubes were placed through radial artery, and dual vena cava catheter was retrograde placed through right internal jugular vein to ensure that the front end was located between the second cervical vertebra and the skull. The nasopharyngeal temperature probe was inserted into the pharyngeal cavity through the nasal cavity. Immediately after tracheal intubation (T1), dura mater incision (T2), tumor 1 hour (T3), dura suture (t4), extubation 10 minutes (t5), body temperature was recorded and blood gas analysis of radial artery and internal jugular vein blood were performed simultaneously. Oxygen saturation, hemoglobin content and so on. Internal carotid artery, internal jugular vein blood oxygen content and difference, cerebral oxygen uptake rate were calculated according to FICK formula. Results: 1.Twenty patients had increased blood oxygen saturation in jugular bulbar, poor blood oxygen content in carotid artery and vein and decreased cerebral oxygen uptake rate. 2. Among them, 18 cases had hypothermia (34.7 鈩，

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