沙滩椅体位及控制性降压下肩关节手术病人脑氧饱和度与脑部血流速度改变及其对术后神经认知的影响  

Changes of Intraoperative Cerebral Oxygen Saturation and Cerebral Blood Flow Velocity in Shoulder Surgery under Beach Chair Position and Controlled Hypotension and Their Relationship with Postoperative Neurocognitive Function

作　　者：何平[1] 史炯[1] 高杨 贺曼曼 董丽蕴 郭亚宁[1] 陈永学[1] HE Ping;SHI Jiong;GAO Yang;HE Manman;DONG Liyun;GUO(Yaning,CHEN Yongxue.Department of Anesthesiology,Handan Central Hospital,Handan 056001,China)

机构地区：[1]邯郸市中心医院麻醉科,河北邯郸056001

出　　处：《骨科》2024年第1期30-35,共6页ORTHOPAEDICS

基　　金：河北省医学科学研究课题(20220019)。

摘　　要：目的分析沙滩椅体位及控制性降压下肩关节手术中脑氧饱和度(rScO_(2))与脑部血流速度的变化,及其对病人术后神经认知的影响。方法选取拟于本院以沙滩椅体位接受肩关节手术治疗的病人60例,均为美国麻醉医师协会(ASA)分级Ⅰ、Ⅱ级,在静脉全身麻醉及控制性降压干预下,于麻醉前、麻醉并转入沙滩椅体位后5 min、手术开始时以及手术开始后每隔20 min直至手术结束进行rScO_(2)、大脑中动脉血流速度(VMCA)和有创血压(心脏水平和耳道水平)的检测,并记录脑氧欠饱和事件(CDE)的发生。同时,于术前和术后24 h对病人进行神经认知能力测试。结果转入沙滩椅体位后所有病人的rScO_(2)和VMCA相比麻醉前都有所下降。经历CDE的病人耳道水平平均动脉压、rScO_(2)和VMCA均显著低于未经历CDE的病人,并且术后24 h时连线测试成绩也更低,组间差异有统计学意义(P<0.05)。结论对于ASA分级Ⅰ、Ⅱ级病人,沙滩椅体位及控制性降压下肩关节手术中部分病人的rScO_(2)和VMCA较麻醉前显著下降并发生CDE,进而对术后神经认知产生不利影响。Objective To analyze the changes of cerebral oxygen saturation(rScO_(2))and cerebral blood flow of patients experiencing shoulder surgery under beach chair position and controlled hypotension,as well as their relationship with postoperative neurocognitive function.Methods A total of 60 patients with I orⅡAmerican Society of Anesthesiologists(ASA)Grades scheduled for shoulder surgery using beach chair position in our hospital were included in the present work.During surgery,the patients took the beach chair position and were treated with intravenous general anesthesia accompanied by a deliberated pressure controlling scheme of hypotension,and measurements of rScO_(2),cerebral middle artery flow velocity(VMCA)and invasive arterial pressure(at heart level and at auditory meatus level)were performed prior to anesthesia induction,5 min after beach chair positioning,at the beginning of operation,and every 20 min thereafter.Moreover,neurocognitive tests were performed prior to and 24 h after surgery.Results For all the patients,both values of rScO_(2) and VMCA decreased 5 min after beach chair positioning.Compared to patients without CDEs,there were lower values of arterial pressures at auditory meatus level,rScO_(2),and VMCA in patients encountered CDEs when turned into beach chair position.Patients with CDEs also acquired worse trial making test results performed 24 h after surgery.The aforementioned inter⁃group differences were all statistically significant(P<0.05).Conclusion A part of ASAⅠandⅡpatients undergoing shoulder surgery under beach chair position and controlled hypotension exhibit significant decreases in rScO_(2) and VMCA compared with values before anesthesia and encounter intraoperative CDEs,which consequently impact postoperative neurocognitive function.

关 键 词：肩关节手术 沙滩椅体位 控制性降压 脑氧饱和度 脑部血流速度 脑氧欠饱和事件 术后神经认知 连线测试 

分 类 号：R687.4[医药卫生—骨科学]