半坐位开颅手术患者无创脑氧饱和度与颈静脉球部血氧饱和度的影响因素分析  

Analysis of influencing factors of non-invasive cerebral tissue oxygen saturation and jugular venous oxygen saturation in patients undergoing semi-sitting craniotomy

作　　者：刘清海[1] 冯华[1] 赵磊[1] 马挺[1] 王天龙[1] Liu Qinghai;Feng Hua;Zhao Lei;Ma Ting;Wang Tianlong(Department of Anesthesiology and Operating Theater,Xuanwu Hospital,Capital Medical University,National Clinical Research Center for Geriatric Disorders,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院麻醉手术科国家老年疾病临床医学研究中心,北京100053

出　　处：《北京医学》2021年第7期612-615,共4页Beijing Medical Journal

摘　　要：目的探讨半坐位开颅患者无创脑氧饱和度(cerebral tissue oxygen saturation,SctO_(2))与颈静脉球部氧饱和度(jugular venous oxygen saturation,SjvO_(2))的影响因素。方法选取2018年4月至2020年5月首都医科大学宣武医院行半坐位听神经瘤手术的患者30例。采用Fore-sight近红外光仪监测无创SctO_(2),通过术侧颈静脉球部置管采集血液标本测定SjvO_(2)。记录半坐位切皮(T0)、硬脑膜剪开后30 min(T1)及肿瘤切除后(T2)双侧无创SctO_(2)及术侧SjvO_(2)、MAP、中心静脉压(central venous pressure,CVP)和颈静脉球部压力(jugular bulb pressure,JBP)。同时采集动脉血测定PaCO_(2)、PaO_(2),采集颈静脉球部血液标本测定颈静脉球部二氧化碳分压(pressure of carbon dioxide in the jugular venous,PjvCO_(2))、颈静脉球部氧分压(pressure of oxygen in the jugular venous,PjvO_(2))、红细胞比容(hematocrit,Hct)及乳酸(lactic acid,Lac),纳入MAP、CVP、JBP、PaCO_(2)、PaO_(2),PjvCO_(2)、PjvO_(2)、Hct及Lac进行SctO_(2)与SjvO_(2)影响因素的多元线性回归分析。结果PjvO_(2)、PjvCO_(2)、PaCO_(2)、JBP和Hct对SjvO_(2)的影响有统计学意义(P<0.05),调整后的R2=0.845;CVP、MAP及PaCO_(2)对术侧SctO_(2)的影响有统计学意义(P=0.000),调整后的R2=0.371。结论半坐位开颅患者采用SctO_(2)和SjvO_(2)监测时需考虑不同的影响因素,采取相应措施有效改善脑氧供需平衡状态。Objective To investigate the influencing factors of cerebral tissue oxygen saturation(SctO_(2))and jugular venous oxygen saturation(SjvO_(2))in patients with semi-sitting craniotomy.Methods A prospective study was conducted on 30 patients who underwent semi-sitting surgery for acoustic neuroma between April 2018 and May 2020.Noninvasive SctO_(2) was monitored by fore-sight near-infrared spectrometer,and blood samples were collected by inserting a tube into the jugular bulb at the operative lateral to determine SjvO_(2).Bilateral noninvasive SctO_(2) and surgical lateral SjvO_(2),MAP,CVP,and jugular bulb pressure(JBP)were recorded after skin incision(T0),30 min after dural incision(T1),and tumor resection(T2).At the same time,arterial blood was collected to determine PaCO_(2) and PaO_(2).Blood samples of jugular were collected to determine the pressure of carbon dioxide in the jugular venous(PjvCO_(2)),pressure of oxygen in the jugular venous(PjvO_(2)),hematocrit(Hct),lactic acid(Lac).MAP,CVP,JBP,PaCO_(2),PaO_(2),PjvCO_(2),PjvO_(2),Hct and Lac were included for multiple linear regression analysis of the influencing factors of SctO_(2) and SjvO_(2).Results The effects of PjvO_(2),PjvCO_(2),PaCO_(2),JBP and Hct on SjvO_(2) were statistically significant(P<0.05),the adjusted R2=0.845;the effects of CVP,MAP and PaCO_(2) on SctO_(2) were statistically significant(P=0.000),the adjusted R2=0.371.Conclusions Different influencing factors should be considered in the monitoring of SctO_(2) and SjvO_(2) in patients with semi-sitting craniotomy,and corresponding measures should be taken to effectively improve the balance of cerebral oxygen supply and demand.

关 键 词：无创脑氧饱和度 颈静脉球部血氧饱和度 影响因素 

分 类 号：R614[医药卫生—麻醉学]