脑氧供需平衡调节对强直性脊柱炎患者截骨矫形手术唤醒试验的影响  

Effect of regulation of balance between cerebral oxygen supply and demand on wake-up test in patients with ankylosing spondylitis undergoing pedicle subtraction osteotomy

作　　者：顾伟[1] 董媛媛[1] 崔士和[1] 吴浩[1] Gu Wei;Dong Yuanyuan;Cui Shihe;Wu Hao(Department of Anesthesiology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,南京210008

出　　处：《中华麻醉学杂志》2024年第12期1464-1469,共6页Chinese Journal of Anesthesiology

基　　金：南京市卫生科技发展专项资金项目(YKK21107);"十四五"江苏省医学重点学科麻醉学(ZDXK202232)。

摘　　要：目的评价脑氧供需平衡调节对强直性脊柱炎患者截骨矫形手术唤醒试验的影响。方法本研究为随机对照研究。选择南京大学医学院附属鼓楼医院2021年7月至2023年4月行经椎弓根椎体截骨矫形手术的强直性脊柱炎患者64例,年龄18~65岁,BMI 18~25 kg/m^(2),ASA分级Ⅱ或Ⅲ级,性别不限。采用随机数字表法分为2组(n=32):干预组(I组)和对照组(C组)。以患者入室水平侧卧呼吸空气时局部脑组织氧饱和度(rSO_(2))为基础值。I组术中维持rSO_(2)波动在基础值10%以内:rSO_(2)>基础值10%时,采取降低P ETCO_(2)和MAP、增加丙泊酚用量、给予甘露醇等措施;当rSO_(2)<基础值10%时,采取提升P ETCO_(2)和MAP、增加吸入氧浓度、输注红细胞等措施。C组仅行rSO_(2)监测,常规麻醉管理。于入室安静侧卧位吸空气状态下(T_(0))、气管插管后10 min(T_(1))、"拱桥形"体位摆放完毕10 min(T_(2))、手术开始后30 min(T_(3))、截骨完毕(T_(4))、术中唤醒(T_(5))、唤醒后30 min(T_(6))、手术结束(T_(7))时记录rSO_(2)。记录唤醒前阶段以及手术全程rSO_(2)升高或降低>基础值10%(持续5 min)的发生情况。唤醒试验期间,评价唤醒质量,记录唤醒时间、Ramsay镇静评分和Riker躁动评分。记录PACU停留时间、气管拔管时间。麻醉苏醒期采用ICU谵妄测评表评估谵妄发生情况,记录疼痛VAS评分。结果与C组比较,I组T_(3)-T_(5)时rSO_(2)降低,T_(6)时rSO_(2)升高,唤醒前阶段rSO_(2)升高>基础值10%的发生率降低(P<0.05),rSO_(2)降低>基础值10%发生率差异无统计学意义(P>0.05),手术全程rSO_(2)升高或下降>基础值10%的发生率降低,唤醒质量分级升高,唤醒时间缩短,唤醒期间Ramsay镇静评分升高,Riker躁动评分降低,PACU停留时间和气管拔管时间缩短,谵妄发生率降低(P<0.05),VAS评分差异无统计学意义(P>0.05)。结论强直性脊柱炎患者截骨矫形手术中采用rSO_(2)导向(维持rSO_(2)波动在基础值10%以Objective To evaluate the effect of regulation of balance between cerebral oxygen supply and demand on wake-up test in patients with ankylosing spondylitis(AS)undergoing pedicle subtraction osteotomy(PSO).MethodsIn this randomized controlled study,64 AS patients of either sex,aged 18-65 yr,with a body mass index of 18-25 kg/m^(2),of American Society of Anesthesiologists Physical Status classificationⅡorⅢ,undergoing PSO in Nanjing Drum Tower Hospital from July 2021 to April 2023,were assigned into intervention group(I group,n=32)and control group(C group,n=32).The regional cerebral oxygen satruation(rSO_(2))breathed in a lateral position after entering the operating room was considered as baseline.In group M,rSO_(2) was maintained within 10%of the baseline value:Lowering the partial pressure of end-tidal CO_(2) and mean arterial pressure,increasing the consumption of propofol and giving mannitol were countermeasures against an elevated rSO_(2)>10%of baseline;whereas elevating partial pressure of end-tidal CO_(2) and mean arterial pressure and increasing the concentration of inhaled oxygen,and transfusing red blood cells were performed in AS patients with a rSO_(2)<10%of baseline in I group.A routine anesthesia management and rSO_(2) monitoring were performed in C group.The rSO_(2) was recorded on admission to the operating room in a quiet lateral position(T_(0)),10 min after tracheal intubation(T_(1)),10 min after the placement of the"arch bridge"position(T_(2)),30 min after the start of operation(T_(3)),at the end of osteotomy(T_(4)),at the time point of intraoperative awakening(T_(5)),30 min after awakening(T_(6)),and at the end of operation(T_(7)).The occurrence of increase and decrease in rSO_(2)>10%of the baseline(for 5 min)during the pre-awakening stage and throughout operation was recorded.The wake-up quality was assessed during the wake-up test.The wake-up time,Ramsay Sedation Scale scores and Riker Sedation-Agitation Scale scores were recorded.The length of stay in postanesthesia care unit and extubat

关 键 词：脊柱炎 强直性 截骨术 唤醒试验 局部脑组织氧饱和度 

分 类 号：R47[医药卫生—护理学]