颅神经疾病显微血管减压术中降低FiO_(2)对术后谵妄及气体交换的影响  

Effects of reducing FiO_(2)during microvascular decompression on postoperative delirium and gas exchange in patients with cranial nerves disorders

作　　者：陈星宇 蔡昌呈 向城卫 曾春[1] CHEN Xing-yu;CAI Chang-cheng;XIANG Cheng-wei;ZENG Chun(Department of Neurosurgery,Suining Central Hospital,Suining 629000,China)

机构地区：[1]遂宁市中心医院神经外科,四川629000

出　　处：《中国临床神经外科杂志》2023年第12期708-711,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨颅神经疾病显微血管减压术(MVD)中吸入氧浓度(FiO_(2))对术后谵妄(POD)及气体交换的影响。方法回顾性分析2014年7月至2023年6月MVD治疗的912例颅神经疾病的临床资料。514例麻醉诱导/苏醒和维持时分别使用1.0和0.5的Fi O_(2)(高FiO_(2)组),398例在麻醉诱导/苏醒和维持给予0.3的FiO_(2)(低FiO_(2)组)。主要终点为术后48 h内动脉血氧分压(PaO_(2))/FiO_(2)比值最小值;次要终点为POD和其他不良事件。结果低FiO_(2)组术后48 h内PaO_(2)/FiO_(2)比值最小值显著高于高FiO_(2)组(P<0.05)。两组POD发生率、发生时间和持续时间均无统计学差异(P>0.05),但是低FiO_(2)组肺不张发生率明显低于高FiO_(2)组(P<0.05)。调整年龄、性别、COPD等因素后,低FiO_(2)组肺不张发生率仍显著降低(OR=1.494;95%CI 1.010~2.211;P=0.044)。结论颅神经夹疾病MVD过程中降低FiO_(2)可能有助于改善术后气体交换,不会增加POD和其他并发症,反而有利于减少术后肺不张。Objective To investigate the effects of reducing fraction of inspiration O_(2)(FiO_(2))during microvascular decompression(MVD)on postoperative delirium(POD)and gas exchange in patients with cranial nerves disorders(CND).Methods The clinical data of 912 patients with primary CND who underwent MVD between July 2014 and June 2023 were retrospectively analyzed.Five hundred and fourteen patients used 1.0 and 0.5 FiO_(2)during anesthesia induction/awakening and maintenance,respectively(High FiO_(2)group)and 398 used 0.3 FiO_(2)throughout anesthesia induction/awakening and maintenance(low FiO_(2)group).The primary endpoint was the minimum ratio of pulmonary arterial oxygen tension(PaO_(2))within 48 hours after surgery to FiO_(2)(PaO_(2)/FiO_(2)),and the scondary endpoints were POD and other adverse events.Results The minimum ratio of PaO_(2)/FiO_(2)in the low FiO_(2)group was significantly higher than that in the high FiO_(2)(P<0.05).There was no significant difference in POD incidence,POD occurrence time and duration between the two groups(P>0.05).However,the incidence of atelectasis in the low FiO_(2)group was significantly lower than that in the high FiO_(2)group(P<0.05).After adjusting the factors such as age,sex,and COPD,the incidence of atelectasis was still significantly reduced in the low FiO_(2)group(OR=1.494;95%CI 1.010~2.211;P=0.044).Conclusions For patients with CND,reducing FiO_(2)during MVD may help improve postoperative gas exchange without increasing POD and other complications,and may actually help reduce postoperative attasis.

关 键 词：颅神经疾病 微血管减压术 术中吸入氧浓度 术后谵妄 气体交换 

分 类 号：R745.1[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]