非插管麻醉的胸腔镜手术中对患者血流动力学及脑氧代谢的变化  

Hemodynamics and cerebral oxygen metabolism in patients undergoing non-intubated video-assisted thoracic surgery

作　　者：王凌飞 詹岳宁 王丹 张艳梅 黄泽清 WANG Lingfei;ZHAN Yuening;WANG Dan;ZHANG Yanmei;HUANG Zeqing(Department of Anesthesiology,Cancer Hospital of China Medical University,Liaoning Cancer Hospital&Institute,Shenyang 110042,China)

机构地区：[1]中国医科大学肿瘤医院,辽宁省肿瘤医院麻醉科,沈阳110042

出　　处：《中国医科大学学报》2024年第12期1111-1117,共7页Journal of China Medical University

摘　　要：目的探讨保留自主呼吸非插管麻醉的胸腔镜手术(NIVATS)对患者血流动力学及脑氧代谢的影响。方法选择2020年5月至2021年9月择期行胸腔镜肺癌根治术或肺楔形切除术患者120例,年龄33~67岁,ASAⅠ~Ⅱ级,随机分为NIVATS组(采用喉罩通气保留自主呼吸)和IVATS组(采用双腔气管插管术中单肺通气),每组60例。记录2组麻醉诱导前(T_(0)),插管(喉罩)即刻(T_(1)),手术开始(单肺通气)后30 min(T_(2))、60 min(T_(3)),拔管(喉罩)后15 min(T_(4))各时间点的心输出量(CO)、每搏量变异率(SVV)、心率变异率(HRV)、血氧饱和度(SpO_(2))、动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2)),同时检测颈内静脉血氧含量(CjvO_(2))、计算动脉-颈内静脉血氧含量差(Da-jvO_(2))及脑氧摄取率(CERO_(2))。结果2组麻醉满意度评分、术野满意度评分、麻醉时间、手术时间比较无统计学差异(均P>0.05);2组术中失血量、术中胶体液量用量、晶体液量用量和淋巴结清扫数量比较无统计学差异(均P>0.05)。与IVATS组比较,NIVATS组T_(1)、T_(2)、T_(3)时CO明显增高,而SVV明显降低(均P<0.05)。两组HRV各时间点比较差异均有统计学意义(均P<0.05)。2组在T_(2)、T_(3)时PaO_(2)、CjvO_(2)比较有统计学差异(均P<0.05)。NIVATS组T_(2)、T_(3)、T_(4)时Da-jvO_(2)、CERO_(2)明显高于IVATS组(均P<0.05)。此外,NIVATS组T_(1)、T_(2)、T_(3)时PaCO_(2)较IVATS组明显增高(均P<0.05)。结论与双腔气管插管术中单肺通气比较,保留自主呼吸非插管麻醉患者术中血流动力学指标(CO、SVV、HRV)更趋于平稳,同时脑氧代谢指标(Da-jvO_(2)、CERO_(2)等)维持在较高的水平,对胸腔镜手术患者术后认知功能恢复可能存在一定促进作用。Objective To explore the effects of preserved voluntary breathing non-intubated video-assisted thoracic surgery(NIVATS)on hemodynamics and cerebral oxygen metabolism in patients.Methods From May 2020 to September 2021,120 patients undergoing elective thoracoscopic radical resection of lung cancer or lung wedge resection,aged 33-67 years,American Society of Anesthesiologists gradesⅠ-Ⅱ,were selected and randomly divided into the NIVATS group(with laryngeal mask ventilation for preserving spontaneous respiration)and the IVATS group(with intraoperative one-lung ventilation with double-lumen tracheal intubation),with 60 patients in each group.The cardiac output(CO),stroke volume variation(SVV),heart rate variation(HRV),oxygen saturation(SpO_(2)),arterial partial pressure of oxygen(PaO_(2)),and partial pressure of carbon dioxide(PaCO_(2))were recorded,and the jugular venous oxygen content(CjvO_(2))was monitored to calculate the arterio-jugular venous oxygen content difference(Da-jvO_(2))and cerebral oxygen extraction ratio(CERO_(2))at five time points.These points were before anesthesia induction(T_(0)),immediately after intubation(laryngeal mask,T_(1)),30 min(T_(2))and 60 min(T_(3))after the start of surgery(one-lung ventilation),and 15 min(T_(4))after extubation(laryngeal mask).Results No statistically significant differences were observed in the scores for satisfaction with anesthesia and the surgical field,duration of anesthesia,or duration of surgery between the two groups(P>0.05 for all).In addition,no statistically significant differences were observed in intraoperative blood loss,intraoperative colloid fluid usage,crystalloid fluid usage,and the number of lymph nodes dissected(P>0.05 for all).Compared with the IVATS group,CO was significantly higher and SVV was significantly lower(P<0.05)at T_(1),T_(2),and T_(3)in the NIVATS group.The difference in HRV between the two groups at each time point was significant(P<0.05).The PaO_(2)and CjvO_(2)in the two groups at T_(2)and T_(3)were significantly different(P<0.

关 键 词：非插管麻醉的胸腔镜手术 血流动力学 脑氧代谢 

分 类 号：R614.2[医药卫生—麻醉学]