沙滩椅位肩关节镜手术对高血压患者脑氧饱和度和术后认知功能的影响

Effect of arthroscopic shoulder surgery in the beach chair position on cerebral oxygen saturation and postoperative cognitive function in patients with hypertension

目的观察沙滩椅位肩关节镜手术对高血压患者脑氧饱和度和术后认知功能的影响。方法将40例ASAⅠ～Ⅱ级肩关节镜手术患者分为两组,20例血压正常者为对照组,20例合并高血压者为实验组。监测麻醉诱导平稳后(为T_1)、沙滩椅位时(为T_2)、控制血压满足术者肩关节镜下手术操作需要后(为T_3)3个时点的颈静脉球静脉血氧饱和度(SjvO_2)和健侧肱动脉平均动脉压(MAP)。记录术前及术后24 h简易智能精神状态检查量表(MMSE)评分,评估患者术后认知功能变化。结果健侧肱动脉MAP对照组和实验组T_2、T_3均低于T_1(P<0.05),T_2、T_3时点与T_1的差值(ΔT_2、ΔT_3)实验组高于对照组(P<0.001)。SjvO_2对照组和实验组T_2、T_3时点均低于T_1(P<0.05),并且T_2时实验组低于对照组(P<0.001)。实验组3例出现了SjvO_2显著下降,分别为45%(T_3)、47%(T_2)和43%(T_3),其对应的健侧肱动脉MAP分别为8.4、9.1、8.7 kPa,及时调整血压后SjvO_2恢复到55%、58%和56%。MMSE评分两组术后24 h与术前比较以及两组之间比较差异均无统计学意义(P>0.05)。结论沙滩椅位和控制性降压时高血压患者健侧肱动脉MAP和SjvO_2下降更显著,两组均未出现术后认知功能障碍。

Objective To observe the effect of shoulder arthroscopic surgery in the beach chair position on cerebral oxygen saturation and postoperative cognitive function in patients with hypertension. Methods Forty patients with ASA gradeⅠ ～ Ⅱ undergoing arthroscopic shoulder surgery in the beach chair position were divided into two groups,20 patients with normal blood pressure as the control group,others with hypertension as the experimental group. The jugular venous oxygen saturation（ SjvO2） and contralateral brachial artery mean arterial pressure（ MAP） were monitored at three time points： after anesthesia induction（ T1）,at beach chair position（ T2） and blood pressure controlled to meet patients arthroscopic operation needs（ T3）. Mini-mental state examination（ MMSE） scores of the preoperation and postoperative 24 h were recorded,and postoperative cognitive function was evaluated. Results The contralateral brachial artery MAP at T2 and T3 were both lower than T1 in control group and experimental group（ P〈0.05）,but the difference value（ ΔT2,ΔT3） of MAP between T2,T3 and T1 in the experimental group were higher than those in the control group（ P〈0.001）. SjvO2 at T2 and T3 were both lower than T1 in control group and experimental group（ P〈0.05）,but the difference value of SjvO2 at T2,T3 and T1 in the experimental group were higher than control group（ P〈0.001）. SjvO2 had significantly decreased in 3 patients of experimental group. They were45%（ at T3）,47%（ at T2） and 43%（ at T3）,respectively. And their corresponding contralateral brachial artery MAP were 8. 4,9. 1,8. 7 k Pa. After adjusting blood pressure,SjvO2 restored to 55%,58% and 56%,respectively.There were no significant differences between the two groups for MMSE scores of preoperation and postoperative 24 h（ P〉0.05）,as well as two groups MMSE scores at postoperative 24 h. Conclusions Contralateral brachial artery MAP and SjvO2 decrease more significantly in patients with hypertension in beach chair position and controlled hypotension,and there are no postoperative cognitive dysfunction in the two groups.