PETCO_(2)和吸入氧浓度水平与胸腔镜肺部手术单肺通气期间脑氧饱和度的关系  

Relationship between the concentration of P ET CO_(2) and inhaled oxygen and cerebral oxygen saturation during one-lung ventilation during thoracoscopic lung surgery.

作　　者：王现雷 刘文超 周立杰 吴振宇[1] WANG Xian-lei;LIU Wen-chao;ZHOU Li-jie(Department of Anesthesia,Qinhuangdao First Hospital,Qinhuangdao Hebei 066000,China.)

机构地区：[1]秦皇岛市第一医院麻醉科,河北秦皇岛066000

出　　处：《临床和实验医学杂志》2023年第19期2123-2126,共4页Journal of Clinical and Experimental Medicine

基　　金：河北省医学科学研究重点课题计划项目(编号:20171260);秦皇岛市科学技术研究与发展计划项目(编号:201902A172)。

摘　　要：目的 探讨呼气末二氧化碳分压(PETCO_(2))和吸入氧浓度(FiO_(2))水平与胸腔镜肺部手术单肺通气期间脑氧饱和度(ScO_(2))的关系。方法 前瞻性选取2020年3月至2022年3月在秦皇岛市第一医院行胸腔镜肺部手术单肺通气患者180例,观察低脑氧合事件发生情况。分析发生和未发生低脑氧合事件患者临床资料,如性别、年龄、体重指数、病理类型、TNM分期、手术体位、麻醉时间、单肺通气时间、手术时间、心率、平均动脉压(MAP)、体温、pH、二氧化碳分压(PaCO_(2))、氧分压(PaO_(2))、吸入氧浓度(FiO_(2))、气道峰压(Ppeak)、PETCO_(2)、肺顺应性等差异。结果 共有66例患者发生低脑氧合事件,低脑氧合事件发生率为36.67%。发生和未发生低脑氧合事件患者性别、年龄、体重指数、病理类型等比较,差异均无统计学意义(P>0.05);发生低脑氧合事件患者动脉血PaCO_(2)、FiO_(2)和Ppeak分别为(38.43±3.34)mmHg、(72.32±8.23)%和(24.54±2.54)cmH2O,明显高于未发生低脑氧合事件患者[(37.02±3.65)mmHg、(63.20±7.56)%和(21.12±2.42)cmH2O],而PETCO_(2)为(41.43±5.32)mmHg,明显低于未发生低脑氧合事件患者[(49.32±6.10)mmHg],差异均有统计学意义(P<0.05)。FiO_(2)与ScO_(2)降低幅度呈正相关(r=0.434,P<0.05),而PETCO_(2)与ScO_(2)降低幅度呈负相关(r=-0.543,P<0.05)。Logistic回归分析,结果显示:FiO_(2)和PETCO_(2)是患者发生低脑氧合事件的影响因素(P<0.05)。结论 PETCO_(2)和FiO_(2)与胸腔镜肺部手术单肺通气期间ScO_(2)降低幅度存在相关性,是患者发生低脑氧合事件的影响因素。Objective To explore the relationship between the levels of partial pressure of end-tidal carbon dioxide(P ET CO_(2))and inhaled oxygen concentration(FiO_(2))and cerebral oxygen saturation(ScO_(2))during one-lung ventilation during thoracoscopic lung surgery.Methods A total of 180 patients with single-lung ventilation undergoing thoracoscopic lung surgery in Qinhuangdao First Hospital from March 2020 to March 2022 were prospectively selected,the occurrence of low cerebral oxygenation events were observed,and the differences in clinical data of patients with and without low cerebral oxygenation events were analyzed,such as gender,age,body mass index,pathological type,TNM staging,surgical position,anesthesia time,single lung ventilation time,surgical time,heart rate,mean arterial pressure(MAP),body temperature,pH,partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),fraction of inspiration O_(2)(FiO_(2)),peak airway pressure(Ppeak),P ET CO_(2),lung compliance,etc.Results A total of 66 patients had low cerebral oxygenation events,and the incidence of low cerebral oxygenation events was 36.67%.There was no significant difference in sex,age,body mass index,pathological type and so on between patients with and without hypooxygenation(P>0.05).The PaCO_(2),FiO_(2) and Ppeak of patients with low cerebral oxygenation events were(38.43±3.34)mmHg,(72.32±8.23)%and(24.54±2.54)cmH 2O,respectively,which were significantly higher than those without low cerebral oxygenation events[(37.02±3.65)mmHg,(63.20±7.56)%,(21.12±2.42)cmH 2O],while P ET CO_(2) was(41.43±5.32)mmHg,which was significantly lower than those without low cerebral oxygenation events[(49.32±6.10)mmHg],the differences were statistically significant(P<0.05).FiO_(2) was positively correlated with the reduction of ScO_(2)(r=0.434,P<0.05),while P ET CO_(2) was negatively correlated with the reduction of ScO_(2)(r=-0.543,P<0.05).Logistic regression analysis showed that FiO_(2) and P ET CO_(2) were the influencing factors for the occurrenc

关 键 词：呼气末二氧化碳分压 吸入氧浓度 胸腔镜肺部手术 单肺通气 脑氧饱和度 

分 类 号：R614[医药卫生—麻醉学]