不同通气方式调控在新生儿胸腔镜术中对脑氧饱和度、血气指标及并发症的影响  

The Effect of Different Ventilation Methods on Cerebral Oxygen Saturation,Blood Gas Indicators,and Complications during Neonatal Thoracoscopy

作　　者：张军 高飞 张力召 董黑雄 ZHANG Jun;GAO Fei;ZHANG Lizhao(Department of Anesthesiology,Xianyang Rainbow Hospital,Xianyang City,Shaanxi Province 712021)

机构地区：[1]咸阳彩虹医院麻醉科,陕西省咸阳市712021

出　　处：《医学理论与实践》2024年第24期4162-4165,共4页The Journal of Medical Theory and Practice

基　　金：咸阳市重点研发计划项目(L2022ZDYFSF075)。

摘　　要：目的:观察不同通气方式调控对新生儿胸腔镜手术期间脑氧饱和度、血气指标及术后并发症的影响。方法:收集本院需要胸腔镜下治疗的新生儿60例,随机分成两组,各30例。A组通过单纯麻醉机调控呼吸频率及吸气压力来控制麻醉脑氧饱和度变化在10%之内,超出范围时通过呼吸频率和吸气压力来调控。B组在A组的基础上同样脑氧饱和度在10%之间变化出现过高或过低时通过手控通气调控,控制治疗的目标是将术中的高碳酸血症和低氧血症控制到一种合理的区间,将脑氧饱和度的下降幅度控制在10%以内同时保证患儿的生命安全。比较两组患儿的术中和术后的rScO_(2)、PETCO_(2)、SpO_(2)、心率、血压、血气分析等指标的变化情况,以及术后的神经系统并发症的发生率。结果:两组患儿的术前基线数据无统计学差异(P>0.05)。A组术中rScO_(2)、PETCO_(2)、SpO_(2)的波动范围较大,rScO_(2)的最低值为(52.3±8.7)%,PETCO_(2)的最高值为(58.4±6.2)mmHg,SpO_(2)的最低值为(88.7±4.3)%;B组术中rScO_(2)、PETCO_(2)、SpO_(2)的波动范围较小,rScO_(2)的最低值为(62.5±7.2)%,PETCO_(2)的最高值为(49.6±5.4)mmHg,SpO_(2)的最低值为(93.4±3.6)%;两组比较差异有统计学意义(P<0.05)。两组患儿的术后rScO_(2)、PETCO_(2)、SpO_(2)恢复到术前水平,无统计学差异(P>0.05)。两组患儿的术前和术后的心率、血压、血气分析等指标无明显异常,无统计学差异(P>0.05)。A组术后出现神经系统并发症的患儿有6例,占20%,主要表现为惊厥、抽搐、脑水肿等,B组术后出现神经系统并发症的患儿有1例,占3.3%,表现为轻度脑水肿,两组比较有统计学差异(P<0.05)。结论:手控通气调控相较于单纯调节呼吸机参数,能更好维持新生儿胸腔镜手术期间血氧、二氧化碳分压在合理水平,降低术后神经系统并发症风险。Objective:To observe the effect of different ventilation methods on cerebral oxygen saturation,blood gas indicators,and complications during neonatal thoracoscopy.Methods:A total of 60 newborns requiring thoracoscopic treatment in our hospital were collected and randomly divided into two groups,30 in each group.Group A controlled the changes in anesthesia brain oxygen saturation within 10%through the adjustment of breathing frequency and inspiratory pressure via an anesthesia machine.If the range was exceeded,control was achieved through breathing frequency and inspiratory pressure adjustments.Based on Group A’s approach,Group B utilized hand-controlled ventilation to regulate rScO_(2)fluctuations within 10%,aiming to maintain hypercapnia and hypoxemia within reasonable limits and ensure the children’s safety by limiting brain oxygen decline to within 10%.The two groups were compared in terms of intraoperative and postoperative rScO_(2),PETCO_(2),SpO_(2),heart rate,blood pressure,blood gas analysis,and the incidence of postoperative neurological complications.Results:There were no significant statistical differences in the preoperative baseline data between the two groups(P>0.05).Group A had larger intraoperative fluctuations in rScO_(2),PETCO_(2),and SpO_(2),with the lowest rScO_(2)value at(52.3±8.7)%,the highest PETCO_(2)at(58.4±6.2)mmHg,and the lowest SpO_(2)at(88.7±4.3)%;group B showed smaller fluctuations,with the lowest rScO_(2)at(62.5±7.2)%,the highest PETCO_(2)at(49.6±5.4)mmHg,and the lowest SpO_(2)at(93.4±3.6)%;statistical significance was found between the two groups(P<0.05).Postoperative rScO_(2),PETCO_(2),SpO_(2)in both groups returned to preoperative levels with no significant statistical differences(P>0.05).There were no significant abnormalities in heart rate,blood pressure,or blood gas analysis before and after surgery in both groups(P>0.05).Group A had 6 cases(20%)of postoperative neurological complications,mainly seizures,convulsions,and cerebral edema,whereas Group B had 1 case(3.3%),

关 键 词：新生儿 胸腔镜 麻醉 脑氧饱和度 通气方式 

分 类 号：R614[医药卫生—麻醉学]