通气策略联合血压调控对沙滩椅体位手术患者脑氧饱和度及术后认知功能的影响  

Impacts of ventilation strategy combined with blood pressure regulation on cerebral oxygen saturation and postoperative cognitive function of patients undergoing beach chair position surgery

作　　者：段丁楠 吕华燕 彭文勇 屠文龙 DUAN Dingnan;LYU Huayan;PENG Wenyong;TU Wenlong(Department of Anesthesiology,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua 321000,China)

机构地区：[1]浙江大学医学院附属金华医院麻醉科,浙江金华321000

出　　处：《中国现代医生》2020年第33期145-148,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2020KY345);浙江省金华市科学技术局公益类项目(2018-4-046)。

摘　　要：目的分析予以沙滩椅体位手术患者通气策略及血压调控对其脑氧饱和度(rSO2)和术后认知功能的影响。方法选择2020年1~7月在本院行肩关节手术的患者120例进行研究,按照随机数字表法分成A组(FiO20.4与PETCO230~35 mmHg)、B组(FiO21.0与PETCO230~35 mmHg)、C组(FiO21.0与PETCO240~45 mmHg)及D组(FiO20.4与PETCO240~45 mmHg),每组各30例,均采取通气策略和血压调控,比较四组不同时间点的rSO2水平、平均动脉压(MAP)与患者术前、术后的认知功能评分、视觉模拟疼痛评分(VAS)及各组恶心呕吐例数。结果四组患者T2的rSO2水平及MAP低于T1,T3、T4及T5时B组rSO2高于A组、C组rSO2高于D组,C组rSO2高于B组、D组rSO2高于A组,差异有统计学意义(P<0.05),T6时rSO2水平及MAP明显高于T5,差异有统计学意义(P<0.05),但各组间MAP比较,差异无统计学意义(P>0.05);四组术前、术后MMSE评分比较,差异无统计学意义(P>0.05);四组术后24 h VAS评分和恶心呕吐例数比较,差异无统计学意义(P>0.05)。结论沙滩椅体位手术采取吸入低氧浓度及较高呼气末二氧化碳联合血压调控,能维持良好的脑部灌注,提供较好的手术视野,同时不会影响患者术后认知功能,安全可靠,值得临床推广。Objective To analyze the impacts of ventilation strategy combined with blood pressure regulation on cerebral oxygen saturation(rSO2)and postoperative cognitive function of patients undergoing beach chair position surgery.Methods A total of 120 patients treated with shoulder joint surgery in our hospital from January to July 2020 were selected for research.According to the method of random number table,they were divided into group A(FiO20.4 and PETCO230-35 mmHg,n=30),group B(FiO21.0 and PETCO230-35 mmHg,n=30),group C(FiO21.0 and PETCO240-45 mmHg,n=30)and group D(FiO20.4 and PETCO240-45 mmHg,n=30),all of which were adopted with ventilation strategy and blood pressure regulation.rSO2 level,mean arterial pressure(MAP),preoperative and postoperative cognitive function score,visual analogue pain score(VAS)and the number of nausea and vomiting were compared among the four groups at different time points.Results rSO2 level and MAP of T2 in four groups decreased compared with T1.At T3,T4 and T5,rSO2 in group B was higher than that in group A,rSO2 in group C was higher than that in group D,rSO2 in group C was higher than that in group B,and rSO2 in group D was higher than that in group A,with statistically significant differences(P<0.05).Compared with T5,the rSO2 level and MAP were increased significantly at T6,with statistically significant differences(P<0.05),but there was no statistically significant difference in MAP among each group(P>0.05).There was no statistically significant difference in MMSE scores among the four groups before and after operation(P>0.05).There were no statistically significant differences in VAS score and nausea and vomiting cases among the four groups at 24 hours after operation(P>0.05).Conclusion Inhalation of low oxygen concentration and higher end-respiratory carbon dioxide combined with blood pressure regulation in beach chair position surgery can maintain good cerebral perfusion,provide better surgical vision,and at the same time will not impact the postoperative cognitive function of pati

关 键 词：沙滩椅体位 血压调控 通气策略 认知功能 脑氧饱和度 

分 类 号：R614.2[医药卫生—麻醉学]