胸科手术单肺通气期间患者局部脑氧饱和度降低的相关因素分析

发布时间：2018-07-13 15:39

【摘要】：目的研究胸科手术单肺通气(OLV)期间与局部脑氧饱和度(rScO_2)下降的相关因素。方法序贯纳入2016年5至10月在北京协和医院实施全麻单肺通气的胸科手术患者33例,ASAⅠ~Ⅲ级。采用静脉诱导,术中吸入七氟醚维持。OLV期间,维持潮气量为6~7 ml/kg,呼气末二氧化碳分压(PetCO_2)在35~45 mmHg(1 mmHg=0.133 kPa)。麻醉过程中,维持脉搏血氧饱和度90%,收缩压90 mmHg或降低不超过基础值的30%,心率50次/min,血红蛋白90 g/L。采用FORESIGHT电极探头持续监测rScO_2,根据术中rScO_2的最低值是否低于65%或较基础值降低15%以上将患者分为低rScO_2组(L-rScO_2组)(n=10)和高rScO_2组(H-rScO_2组)(n=23)。比较两组患者的性别、年龄、体质量指数、术中血红蛋白及rScO_2最低时点的气道峰压(Ppeak)、收缩压、PetCO_2和SpO_2。结果 L-rScO_2组的Ppeak显著高于H-rScO_2组(P=0.028),而收缩压显著低于H-rScO_2组(P=0.046),L-rScO_2组的SpO_2有低于H-rScO_2组的趋势,但差异无统计学意义(P=0.421)。非条件Logistic回归分析示Ppeak是导致OLV期间rScO_2降低的相关因素。结论胸科手术OLV期间,Ppeak与术中rScO_2的下降存在关联。
[Abstract]:Objective to study the factors related to the decrease of regional cerebral oxygen saturation (rsco _ 2) during single lung ventilation (OLV) in thoracic surgery. Methods from May to October 2016, 33 patients undergoing single lung ventilation under general anesthesia in Beijing Union Hospital were enrolled in this study. After intravenous induction, the tidal volume was 6 ~ 7 ml / kg, and the end-expiratory carbon dioxide partial pressure (PetCO2) was 35 ~ 45 mmHg (1 mm HgG 0.133 KPA) during the maintenance of OLV by inhalation of sevoflurane. During anesthesia, maintain pulse oxygen saturation 90, systolic blood pressure 90 mmHg or decrease the baseline value by 30, heart rate 50 beats / min, hemoglobin 90 g / L. Using FORESIGHT electrode probe to continuously monitor rScO2s, patients were divided into low rScO2 group (L-rScO2 group) and high rScOStates2 group (H-rScOSn2 group) according to whether the minimum value of rScO2 during operation was lower than 65% or more than 15% lower than the basic value. The patients were divided into low rScO2 group (L-rScO2 group) and high rScOSn2 group (H-rScOSn2 group) (nc23). Gender, age, body mass index, intraoperative hemoglobin and peak airway pressure (Ppeak) at the lowest time point of rScO2, systolic blood pressure, PetCO2 and Spo _ 2 were compared between the two groups. Results the Ppeak of group L-rScO2 was significantly higher than that of group H-rScO _ 2 (P _ (0.028), but the systolic pressure was significantly lower than that of group H-rScO _ (2) (P _ (0.046). The SPO _ (2) of group L ~ (rScO) _ 2 was lower than that of group H-rScO _ (2), but there was no significant difference (P _ (0.421). Non-conditional logistic regression analysis showed that Ppeak was the related factor that led to the decrease of rScOII during OLV. Conclusion there is a correlation between Ppeak during OLV and the decrease of rsco _ 2 during operation.
【作者单位】：中国医学科学院北京协和医学院北京协和医院麻醉科;北京市房山区第一医院麻醉科;
【分类号】：R614

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