治疗性高碳酸血症对沙滩椅位胸腔镜手术患者脑氧代谢的影响  

Effect of therapeutic hypereapnia on cerebral oxygen metabolism in patients undergoing thoraco- scopic surgery in beach chair position

作　　者：林峰[1] 陈新忠[1] 陈玲阳[2] 王明仓[2] 

机构地区：[1]浙江大学医学院附属妇产科医院麻醉科,杭州市310000 [2]浙江省台州医院麻醉科,317000

出　　处：《中华麻醉学杂志》2016年第11期1341-1344,共4页Chinese Journal of Anesthesiology

摘　　要：目的评价治疗性高碳酸血症对沙滩椅位胸腔镜手术患者脑氧代谢的影响。方法择期胸腔镜下双侧胸交感神经链切断术患者60例，年龄18～32岁，性别不限，BMI 19～24 kg/m2，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将其分为2组（n＝30）：对照组（C组）和高碳酸血症组（H组）。2组全麻诱导气管插管后行机械通气，采用小潮气量间歇正压通气联合低水平PEEP（5 cmH2O）的通气策略，维持PaCO2 35～45 mmHg；沙滩椅位后通过调节通气频率，H组维持PaCO2 45～55 mmHg。麻醉维持：靶控输注异丙酚，间断追加罗库溴铵和舒芬太尼，维持BIS值45～55。分别于麻醉诱导前（基础状态）、气管插管后5 min、沙滩椅位5、10、15、20 min时采集桡动脉和颈静脉球部的血样，进行血气分析，计算动脉-颈静脉血氧含量差、脑氧摄取率和颈静脉-动脉血乳酸浓度差。结果与C组比较，H组沙滩椅位期间PaCO2和颈静脉球部血氧饱和度升高，动脉-颈静脉血氧含量差和脑氧摄取率降低（P〈0.05）；2组各时点颈静脉-动脉血乳酸浓度差比较差异无统计学意义（P〉0.05）。结论治疗性高碳酸血症有助于改善沙滩椅位胸腔镜手术患者脑氧代谢。ObjectiveTo evaluate the effect of therapeutic hypercapnia on cerebral oxygen metabolism in the patients undergoing thoracoscopic surgery in beach chair position （BCP）.MethodsSixty patients of both sexes, aged 18-32 yr, with body mass index of 19-24 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective bilateral thoracic sympathectomy performed via a thoracoscope, were divided into control group （group C） and hypercapnia group （group H）, with 30 patients in each group using a random number table.After induction of anesthesia, all the patients in both groups were tracheally intubated and mechanically ventilated using the ventilation regimen low tidal volume intermittent positive pressure ventilation combined with low level of positive end-expiratory pressure （5 cmH2O）, maintaining arterial carbon dioxide partial pressure （PaCO2） at 35-45 mmHg.PaCO2 was maintained at 45-55 mmHg by adjusting the respiratory rate after the patients were placed in BCP in group H. Anesthesia was maintained with target-controlled infusion of propofol and intermittent intravenous boluses of rocuronium and sufentanil.Bispectral index value was maintained at 45-55.Before anesthesia induction （baseline）, at 5 min after intubation, and at 5, 10, 15 and 20 min after the patients were placed in BCP, blood samples were taken from the radial artery and jugular bulb for blood gas analysis, jugular venous bulb oxygen saturation was measured, and arteriovenous blood O2 content difference, cerebral O2 extraction rate, and venous to arterial blood lactate concentration difference were calculated.ResultsCompared with group C, PaCO2 and jugular venous bulb oxygen saturation were significantly increased, and arteriovenous blood O2 content difference and cerebral O2 extraction rate were significantly decreased at at 5, 10, 15 and 20 min after the patients were placed in BCP in group H （P〈0.05）, and there was no significant change in venous to arterial blood lactate concentration d

关 键 词：高碳酸血 体位 氧耗量 脑 

分 类 号：R614[医药卫生—麻醉学]