局部脑氧饱和度在术后麻醉苏醒期患者意识水平变化中监测价值

Value of regional cerebral oxygen saturation in monitoring consciousness recovery during postoperative anesthesia

目的 探究局部脑氧饱和度(rSO_(2))在腔镜肺叶切除麻醉苏醒期患者意识水平变化中的监测价值。方法 选择2019年2月至2021年10月于秦皇岛市第一医院行腔镜肺叶切除术的76例早期非小细胞肺癌(NSCLC)患者,其中男性39例,女性37例;年龄49~76岁,平均年龄62.36岁;病程6~14个月,平均病程7.92个月;体质量指数(BMI)18.35~24.62 kg/m^(2),平均BMI 22.65 kg/m^(2);TNM分期Ⅰ期42例,Ⅱ期34例;麻醉时间79~149 min,平均麻醉时间126.35 min。采取近红外光谱法(NIRS)对患者rSO_(2)进行实时监测,分别记录其基线值、第一次反应前和反应时及意识恢复时左右两侧rSO_(2)值(rSO_(2)-L、rSO_(2)-R)、动脉压(MAP)、呼气末二氧化碳分压(P_(ET)CO_(2))、指脉氧饱和度(SpO_(2))和心率(HR)。记录不同时间点患者rSO_(2)-L、rSO_(2)-R、MAP、P_(ET)CO_(2)、SpO_(2)和HR,并对意识恢复延迟的患者不同时间点进行二次比较,通过受试者操作特性(ROC)曲线比较各指标对患者意识变化的评估效能。结果 rSO_(2)-L、rSO_(2)-R、MAP和HR数据在第一次反应时与基线值相比均明显上升[(76.62±5.19)%vs(72.62±5.36)%、(78.34±5.21)%vs(72.59±5.27)%、(93.14±13.57) mm Hg vs (87.53±13.08) mm Hg、(70.43±10.26)次/分vs (61.32±10.23)次/分。P=0.000 0<0.01],而P_(ET)CO_(2)和SpO_(2)在不同时间点无明显变化(P>0.05)。对于患者麻醉苏醒期的评估,rSO_(2)-L、rSO_(2)-R、MAP和HR的AUC分别为0.786、0.815、0.650、0.680,灵敏度分别为80.3%、76.3%、55.3%、63.20%,特异度分别为86.8%、82.9%、72.4%、68.4%,rSO_(2)-L和rSO_(2)-R灵敏度与特异度均高于MAP和HR。在76例患者中,9例患者意识恢复延迟。比较不同时间点rSO_(2)-L、rSO_(2)-R、MAP和HR的变化水平发现,rSO_(2)-L和rSO_(2)-R在意识恢复时与基线值相比均明显上升[(81.29±4.06)%vs(72.45±5.32)%、(80.72±4.55)%vs(72.59±5.08)%。P<0.01],而MAP和HR在不同时间点无明显变化[(94.38±9.72) mm Hg vs (88.55±9.01) mm Hg、(70.53±12.26)次/分vs (61.15±7.17)次/分。P>0.05]。结论 大脑rSO_(2)水平变化与麻醉后意识恢复过程有关。在预测行腔镜肺叶切除术的NSCLC患者麻醉苏醒状态时,rSO_(2)的预测效果优于交感神经预测效果,能够通过检测rSO_(2)对患者麻醉后意识恢复水平进行有效评估。

Objective To investigate the value of regional cerebral oxygen saturation(rSO_(2))in monitoring consciousness recovery during thoracoscopic lobectomy anesthesia.Method From February 2019 to October 2021,a total of 76 patients with earlystage non-small cell lung cancer(NSCLC)who underwent laparoscopic lobectomy were enrolled,which included 39 males and37 females,aged 49-76 years old with mean age of 62.36 years old;disease course was 6-14 months with mean of 7.92months;body mass index(BMI)was 18.35-24.62 kg/m~2with mean BMI of 22.65 kg/m~2;42 cases were TNM stageⅠand 34 cases were stageⅡ;anesthesia time was 79-149 minutes with mean of 126.35 minutes.The near-infrared spectroscopy(NIRS)was used to monitor rSO_(2)in real time,and baseline value,rSO_(2)values(rSO_(2)-L,rSO_(2)-R),mean arterial pressure(MAP),end expiratory carbon dioxide partial pressure(P_(ET)CO_(2)),blood oxygen saturation(SpO_(2))and heart rate(HR)at left and right sides before and during the first reaction consciousness recovery were recored.The rSO_(2)-L,rSO_(2)-R,MAP,P_(ET)CO_(2),SpO_(2)and HR at different time points were recorded,the secondary comparison at different time points were performed in patients with delayed consciousness recovery,and the receiver operating characteristic(ROC)curves were used to compare efficacy of each index in assessing consciousness changes.Results Compared with baseline values,rSO_(2)-L,rSO_(2)-R,MAP and HR were significantly elevated at the first response[(76.62±5.19)%vs(72.62±5.36)%,(78.34±5.21)%vs(72.59±5.27)%,(93.14±13.57)mm Hg vs(87.53±13.08)mm Hg,(70.43±10.26)times/minutes vs(61.32±10.23)times/minutes.P=0.0000<0.01],while there were no significant changes in PETCO_(2)and SpO_(2)at different time points(P>0.05).For anesthesia recovery assessment,AUC of rSO_(2)-L,rSO_(2)-R,MAP and HR was 0.786,0.815,0.650,0.680,sensitivity was 80.3%,76.3%,55.3%,63.20%,and specificity was 86.8%,82.9%,72.4%,68.4%,respectively.The sensitivity and specificity of rSO_(2)-L and rSO_(2)-R were better than MAP and HR.Of 76 patients,9 patients showed delayed recovery of consciousness.The levels change of rSO_(2)-L,rSO_(2)-R,MAP and HR at different time points were compared,levels of rSO_(2)-L and rSO_(2)-R at consciousness recovery were significantly increased than baseline[(81.29±4.06)%vs(72.45±5.32)%,(80.72±4.55)%vs(72.59±5.08)%.P<0.01],while there were no significant changes in MAP and HR at different time points[(94.38±9.72)mm Hg vs(88.55±9.01)mm Hg,(70.53±12.26)times/minutes vs(61.15±7.17)times/minutes.P>0.05].Conclusion It is demonstrated that changes of rSO_(2)levels in brain are associated with consciousness recovery from anesthesia.The rSO_(2)is superior to sympathetic nerve in predicting anesthesia recovery state of NSCLC patients performed laparoscopic lobectomy,which could effectively evaluate the level of consciousness recovery in patients after anesthesia by detecting rSO_(2).