治疗性高碳酸血症对沙滩椅位下肩关节镜手术患者脑氧供需平衡的影响  

Effect of therapeutic hypercapnia on balance between cerebral O2 supply and demand in patients undergoing arthroscopic shoulder surgery in beach chair position

作　　者：左友梅[1] 李珺[1] 程新琦[1] 刘学胜[1] 顾尔伟[1] 

机构地区：[1]安徽医科大学第一附属医院麻醉科,合肥市230022

出　　处：《中华麻醉学杂志》2017年第10期1176-1179,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（BCP）下肩关节镜手术患者脑氧供需平衡的影响.方法 择期拟行沙滩椅位肩关节镜手术患者48例,性别不限,年龄21～64岁,体重45～80 kg,ASA分级Ⅰ或Ⅱ级.采用随机数字表法分为2组（n=24）：对照组C组）和治疗性高碳酸血症组（H组）.于诱导后BCP前、BCP后即刻、3、6、9、12、15、18、21、24、27、30 min和术毕（T0-12）时记录脑氧饱和度（rSO2）;记录脑去氧饱和度事件（CDE）的发生情况、拔除气管导管时间、PACU滞留时间、恶心、呕吐的发生情况和血管活性药物使用情况.结果 与T0时比较,C组T1-12时rSO2降低,H组T2-6时rSO2下降（P〈0.05）;与C组比较,H组T1-12时rSO2升高,CDE发生率降低（P〈0.05）;2组拔除气管导管时间、PACU滞留时间、恶心、呕吐的发生率和血管活性药物使用率差异无统计学意义（P〉0.05）.结论 治疗性高碳酸血症可改善BCP下肩关节镜手术患者的脑氧供需平衡.Objective To evaluate the effect of therapeutic hypercapnia on the balance between cer-ebral O2supply and demand in the patients undergoing arthroscopic shoulder surgery in the beach chair posi-tion（BCP）. Methods Forty-eight patients of both sexes, aged 21-64 yr, weighing 45-80 kg, of Ameri-can Society of Anesthesiologists physical statusⅠorⅡ, scheduled for elective arthroscopic shoulder surgery in the beach chair position, were divided into 2 groups（n=24 each）using a random number table： control group（group C, end-tidal pressure of carbon dioxide 35-40 mmHg）and therapeutic hypercapnia group （group H, end-tidal pressure of carbon dioxide 45-50 mmHg）. The regional cerebral oxygen saturation （rSO2）was recorded after induction and before BCP, immediately after BCP, at 3, 6, 9, 12, 15, 18, 21, 24, 27 and 30 min after BCP and at the end of surgery（T0-12）. The occurrence of cerebral desaturation events, extubation time, duration of stay in postanesthesia care unit, development of nausea and vomiting and requirement for vasoactive drugs were recorded during surgery. Results Compared with the baseline at T0, the rSO2was significantly decreased at T1-12in group C and at T2-6in group H（P〈0.05）. The rSO2was significantly higher at T1-12, and the incidence of cerebral desaturation events was lower in group H than in group C（P〈0.05）. There was no significant difference between the two groups in the extubation time, dura-tion of stay in postanesthesia care unit, incidence of nausea and vomiting or requirement for vasoactive drugs （P〉0.05）. Conclusion Therapeutic hypercapnia can improve the balance between cerebral O2supply and demand in the patients undergoing arthroscopic shoulder surgery in the BCP.

关 键 词：高碳酸血 体位 脑 肩关节 氧耗量 

分 类 号：R614[医药卫生—麻醉学]