脑氧饱和度监测用于指导巨大腹膜后肿瘤切除术患者脑保护的研究

Effect of perioperative cerebral oximetry on outcome of huge retroperitoneal tumor surgery

目的探讨围术期局部脑氧饱和度(regional cerebral oxygen saturation,rScO_2)监测用于指导脑氧供需平衡在巨大腹膜后肿瘤切除术患者脑保护中的意义。方法选择37例巨大腹膜后肿瘤手术患者,围术期监测rScO_2、动脉血气分析、桡动脉压和心输出量等,以rScO_2为主要观察指标进行临床干预,改善和维护患者术中脑氧供需平衡。结果肿瘤切除过程中rScO_2较切除前明显下降,差异有统计学意义(P<0.05);经过有效的临床干预,肿瘤切除后rScO_2与切除中比较显著提高(P<0.05);2例患者循环波动大,rScO_2监测数值低于50%,术后出现苏醒延迟和癫痫发作。结论术中rScO_2监测对患者围术期脑氧供需平衡的管理具有重要指导意义,全面监测与有效调控是患者良好转归的基础。

Objective To observe the effect of maintance of regional cerebral oxygen saturation （rScO2） on outcome of huge retroperitoneal tumor surgery. Methods Thirtyseven patients were enrolled in the study, the rScO2, blood gas, MBP and cardiac output （CO） were continuously monitored and recorded during perioperative period. The intervention stratergy was adjusted according the rScO2 changes to maintain the cerebral oxygen balance. Results There were significant difference in rScO2 during huge retroperitoneal tumor excision （P 〈 0.05）. The rScO2 of the patients increased following clinical intervention after tumor excision. Two patients whose rScO2 less than 50%, had postoperative recovery delay and epilepdic seizure. Conclusion The maintance of perioperative cerebral oximetry could improve patient＇ s outcome of the huge retroperitoneal tumor surgery.