不同通气策略在控制性降压下对沙滩椅体位手术患者脑氧饱和度的影响研究

Research on the impacts of different ventilation strategies on regional cerebral oxygen saturation in patients undergoing sand-beach-chair position surgery under controlled hypotension

目的探讨在控制性降压时不同通气策略对沙滩椅体位手术患者脑氧饱和度(rSO2)的影响。方法选取2018年1月~2020年1月于浙江省金华市中心医院入院接受肩关节镜手术治疗的104例患者作为研究对象,参照双盲法将104例患者分为1组、2组、3组和4组,每组各26例,所有患者均使用静脉麻醉,行气管插管,在摆出沙滩椅体位后实施通气干预,其中1组吸入氧浓度(FiO2)为0.4,呼末二氧化碳分压(PETCO2)为30~35 mmHg;其余三组FiO2和PETCO2分别调整为1.0和30~35 mmHg、0.4和40~45 mmHg及1.0和40~45 mmHg,选用近红外光谱仪监测患者rSO2,比较四组平均动脉压(MAP)、rSO2和简易智力状态检查表(MMSE)之间的差异。结果与T0阶段相比,1组、2组、3组和4组T1阶段MAP和rSO2之间存在明显差异(P<0.05);与T4阶段相比,1组、2组、3组和4组T5阶段的rSO2之间存在明显差异(P<0.05);在T2~T4阶段2组rSO2明显高于1组,4组高于3组,在T1~T5阶段4组rSO2明显高于2组,3组rSO2高于1组,差异有统计学意义(P<0.05);但四组在不同阶段MMSE量表评分之间无明显区别,差异无统计学意义(P>0.05)。结论在沙滩椅体位患者的手术过程中,采用低吸入氧浓度和高呼末二氧化碳分压的通气策略,可有效保障在控制性降压状态下予以患者脑氧供需良好的脑部灌注,适用于肩关节镜手术。

Objective To investigate the impacts of different ventilation strategies on regional cerebral oxygen saturation(rSO2)in patients undergoing sand-beach-chair position surgery under controlled hypotension.Methods From January 2018 to January 2020,a total of 104 patients with shoulder arthroscopic surgery in Jinhua Municipal Central Hospital were selected as the research objects.According to the double-blind method,all of the 104 patients were divided into groupⅠ(n=26),groupⅡ(n=26),groupⅢ(n=26)and groupⅣ(n=26).They were treated with intravenous anesthesia,endotracheal intubation and ventilation intervention after posing the sand-beach-chair position.Among them,the fraction of inspired oxygen(FiO2)of groupⅠwas 0.4,and the end-tidal carbon dioxide partial pressure(PETCO2)was 30-35 mmHg.The FiO2 and PETCO2 of the other three groups were adjusted to 1.0 and 30-35 mmHg,0.4 and 40-45 mmHg as well as 1.0 and 40-45 mmHg respectively.The rSO2 of patients was monitored by near infrared spectrometer,and the differences of the mean arterial pressure(MAP),rSO2 and mini mental state examination(MMSE)among the four groups were compared.Results Compared with stage T0,there were significant differences in MAP and rSO2 of groupⅠ,groupⅡ,groupⅢand groupⅣin stage T1(P<0.05).Compared with stage T4,there were significant differences in rSO2 of groupⅠ,groupⅡ,groupⅢand groupⅣin stage T5(P<0.05).rSO2 of groupⅡandⅣwere significantly higher than those of groupⅠandⅢrespectively in stages T2-T4,and rSO2 of groupⅣandⅢwere significantly higher than those of groupⅡandⅠrespectively in stages T1-T5.There were significant differences between the groups(P<0.05).However,there was no significant difference between the four groups in MMSE scale score at different stages(P>0.05).Conclusion During the surgery of patients in sand-beach-chair position,the ventilation strategies of low concentration of FiO2 and high concentration of PETCO2 can effectively guarantee the cerebral perfusion with good supply and demand of cerebral oxygen under the condition of controlled hypotension,which is more suitable for shoulder arthroscopic surgery.