局部脑氧饱和度指导控制性降压对合并高血压的老年脊柱手术患者出血量及术后康复的影响

The effect on bleeding volume and postoperative recovery of regional cerebral oxygen saturation guides controlled hypotension in elderly patients with hypertension undergoing spinal surgery

目的评价局部脑氧饱和度(rSO2)监测指导控制性降压对合并高血压的老年脊柱手术患者出血量及术后康复的影响。方法选择2017年1月至2019年12月在青岛市市立医院东院麻醉科及青岛大学附属医院麻醉科择期行脊柱手术老年患者120例,按照随机数字表法,分为2组(n=60):rSO2指导术中控制性降压组(A组)和对照组(C组)。2组均采用气管插管全身麻醉,全程监测rSO2,七氟醚+瑞芬太尼维持麻醉并行控制性降压,必要时使用硝普钠+艾司洛尔。A组行控制性降压的同时,以rSO2维持于64±3之内或rSO2下降≤基础值10%及术野渗血量适度减少为目标。C组行常规麻醉管理,以平均动脉压(MAP)降低程度≥基础值30%及术野渗血量适度减少为目标。比较2组患者术中出血量及术毕尿量,术后低体温、谵妄、寒战及恶心呕吐的发生率,术后恢复室(PACU)停留时间,术后引流量,进食时间及术后住院天数。结果A组、C组出血量分别为(589±157)、(764±213)ml,术毕尿量分别为(778±121)、(1079±239)ml,差异均有统计学意义(t=-5.120、-8.712,均P<0.05)。A组术后低体温、谵妄、寒战及恶心呕吐发生率分别为26.7%、18.3%、10.0%、21.7%,C组分别为45.0%、36.7%、25.0%、40.0%,差异均有统计学意义(χ^2=4.385、5.057、4.675、4.728,均P<0.05)。A组PACU停留时间、术后引流量、进食时间及术后住院天数分别为(56±9)min、(217±66)ml、(17.8±2.8)h、(7.2±2.7)d,C组分别为(63±11)min、(289±81)ml、(22.3±4.1)h、(8.2±2.9)d,差异均有统计学意义(t=-3.399、-5.334、-7.000、-2.031,均P<0.05)。结论rSO2监测指导控制性降压可以减少合并高血压的老年脊柱手术患者术中出血量,降低术后相关并发症,加快术后康复。

Objective To evaluate the effect on bleeding volume and postoperative recovery of regional cerebral oxygen saturation(rSO2)guides controlled hypotension in elderly patients with hypertension undergoing spinal surgery.Methods One hundred and twenty elderly patients who underwent spinal surgery in the department of anesthesiology of Qingdao Municipal Hospital and the Affiliated Hospital of Qingdao University from January 2017 to December 2019 were selected and divided into 2 groups according to the random number table method(n=60):rSO2 guides the controlled hypotension group(group A)and control group(group C).Both groups were performed with endotracheal intubation for general anesthesia,maintain anesthesia with sevoflurane and remifentanil,rSO2 were monitored throughout the procedure.If necessary,sodium nitroprusside or esmolol were used to control blood pressure.In group A,the goal of controlled hypotension was that rSO2 decreased≤10%of the basic value or maintained at 64±3 and the moderate operative field bleeding.Group C underwent routine anesthesia management.Intraoperative blood loss and urine output,the incidence of hypothermia after operation,postoperative delirium,chills,nausea and vomiting,the PACU residence time,postoperative drainage volume,eating time,postoperative hospital stay were compared between the two groups.Results Compared with group C,the blood loss[(589±157)vs(764±213)ml]and urine output[(778±121)vs(1079±239)ml]of group A were decreased(t=-5.120,-8.712,all P<0.05).The rates of hypothermia after operation(26.7%vs 45.0%),postoperative delirium(18.3%vs 36.7%),chills(10.0%vs 25.0%),nausea and vomiting(21.7%vs 40.0%)of group A were decreased(χ^2=4.385,5.057,4.675,4.728,all P<0.05).The PACU residence time[(56±9)vs(63±11)min],postoperative drainage volume[(217±66)vs(289±81)ml],eating time[(17.8±2.8)vs(22.3±4.1)h]and numbers of days in hospital[(7.2±2.7)vs(8.2±2.9)d]were decreased of group A(t=-3.399,-5.334,-7.000,-2.031,all P<0.05).Conclusion The guidance of controlled hypotension with rSO2 monitoring can reduce the blood loss and infusion volume during spinal surgery in elderly patients with hypertension,reduce postoperative related complications and enhance recovery after surgery.