胸科手术患者单肺通气期间rScO2降低的危险因素  

Risk factors for decrease in regional cerebral oxygen saturation during one-lung ventilation in patients undergoing thoracic surgery

作　　者：赵伟[1] 贾慧群[1] 李超[1] 张东莹 王之骄 申军梅[1] Zhao Wei;Jia Huiqun;Li Chao;Zhang Dongying;Wang Zhijiao;Shen Junmei(Department of Anesthesiology,Forth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院麻醉科,石家庄050011

出　　处：《中华麻醉学杂志》2020年第5期548-551,共4页Chinese Journal of Anesthesiology

基　　金：河北省医学科学研究重点课题(20190709)。

摘　　要：目的筛选胸科手术患者单肺通气期间局部脑氧饱和度(rScO2)降低的危险因素。方法选择2017年8月至2018年9月择期拟行胸科手术且需要单肺通气的患者175例,性别不限,年龄≥55岁,预计手术时间≥2 h。于麻醉诱导前开始持续监测rScO2至拔除气管插管后结束。采用全麻、全麻联合硬膜外阻滞或全麻联合局部神经阻滞。记录患者一般情况、既往病史和麻醉手术史、手术类型、麻醉方式、麻醉时间、单肺通气时间、手术时间和术中不良事件(低氧血症、低血压和心动过缓等)发生情况。根据单肺通气期间是否发生rScO2降低(rScO2绝对值小于65%或较基础值降低大于20%),将患者分为2组:rScO2降低组和rScO2正常组。采用多因素logistic回归分析筛选单肺通气期间rScO2降低的危险因素。结果有107例患者单肺通气期间发生了rScO2降低,发生率为61.1%。logistic回归分析结果显示,低氧血症是胸科手术患者单肺通气期间rScO2降低的独立危险因素,全麻联合硬膜外阻滞是rScO2降低的保护性因素(P<0.05)。结论低氧血症是胸科手术患者单肺通气期间rScO2降低的独立危险因素,而全麻联合硬膜外阻滞是其保护性因素。Objective To identify the risk factors for decrease in regional cerebral oxygen saturation(rScO2)during one-lung ventilation(OLV)in the patients undergoing thoracic surgery.Methods A total of 175 patients of both sexes,aged≥55 yr,with expected operation time≥2 h,scheduled for elective thoracic surgery with OLV,were selected in the Fourth Hospital of Hebei Medical University from August 2017 to September 2018.The rScO2 was continuously monitored from the beginning of anesthesia induction until removal of tracheal intubation.General anesthesia,general anesthesia combined with epidural block or general anesthesia combined with local nerve block were used.The baseline characteristics,previous medical history and history of anesthesia surgery,type of surgery,method of anesthesia,duration of anesthesia,duration of OLV,duration of surgery,and intraoperative adverse events(hypoxemia,hypotension,bradycardia,etc.)were recorded.According to whether a decrease in rScO2 occurred during OLV(absolute value of rScO2 was less than 65%or a decrease of more than 20%of the baseline value),the patients were divided into 2 groups:low rScO2 group and normal rScO2 group.Multivariate logistic regression analysis was used to identify the risk factors for decrease in rScO2 during OLV.Results One hundred and seven patients developed decrease in rScO2 during OLV,with an incidence of 61.1%.The results of logistic regression analysis showed that hypoxemia was an independent risk factor for decrease in rScO2,and general anesthesia combined with epidural block was a protective factor for decrease in rScO2 during OLV.Conclusion Hypoxemia is an independent risk factor for decrease in rScO2 during OLV,while general anesthesia combined with epidural block is a protective factor for decrease in rScO2 in the patients undergoing thoracic surgery.

关 键 词：脑 氧 单肺通气 胸外科手术 危险因素 

分 类 号：R614[医药卫生—麻醉学]