腹腔镜直肠癌手术对脑氧供需平衡及脑血流的影响

Laparoscopic Rectal Cancer Surgery Influence on Cerebral Oxygen Supply-demand Balance and Cerebral Blood Flow

目的观察腹腔镜直肠癌切除术中CO2气腹对脑氧供需平衡及脑血流的影响。方法所有患者在麻醉前、CO2气腹前、CO2气腹后10、30min和关气腹后10、30min,分别采集颈内静脉球部和桡动脉血,进行动、静脉血气分析,及血氧饱和度(SaO2)监测,并根据Fick公式计算动脉血氧值(CaO2)、颈内静脉球部血氧含量(CjvO2)和脑动、静脉血氧含量(CajvDO2)。结果气腹前与麻醉前比较SaO2、CaO2、PjvO2、CajvDO2等指标变化不显著,而气腹后10与30min的各项指标明显有差异,特别是脑动、静脉血氧值较前明显降低。结论在腹腔镜直肠癌手术过程中采集颈内静脉球部和桡动脉血,进行动、静脉血气分析,及血氧饱和度(SaO2)监测,可以有效反应出脑氧供需平衡及脑血流情况,可以使术者及时了解患者情况,并做出相应的治疗。

Objective To observe Laparoscopic rectal cancer resection CO2 pneumoperitoneum influence on cerebral oxygen and cerebral blood flow.Methods All patients before anesthesia,CO2 pneumoperitoneum,CO2 pneumoperitoneum after 10 hours,30 minutes and off 10 minutes after pneumoperitoneum,30 minutes,were collected from jugular bulb and radial artery,for arterial and venous blood gas analysis,and oxygen saturation（SaO2） monitoring,and arterial oxygen calculated according to Fick value（CaO2）,jugular bulb oxygen content（CjvO2） and cerebral arterial and venous oxygen content（CajvDO2）.Results Before anesthesia,before pneumoperitoneum compared SaO2,CaO2,PjvO2,CajvDO2 other indicators did not change significantly,but 10 minutes after pneumoperitoneum and 30 minutes of apparent differences in the indicators,especially the cerebral arterial and venous blood oxygen values than before decreased.Conclusion Laparoscopic colorectal surgery in the process of collecting jugular bulb and radial artery,for arterial and venous blood gas analysis,and oxygen saturation（SaO2） monitoring can reflect the balance of cerebral oxygen and cerebral blood flow circumstances,can make surgery patients informed of the situation and make the appropriate treatment.