肌氧饱和度指导对腰椎手术患者术后早期恢复质量的影响

Effect of muscle oxygen saturation guidance on early recovery quality of patients after spinal surgery

目的:评价肌氧饱和度(SmtO_(2))指导对腰椎手术患者术后早期恢复质量的影响。方法:择期行脊柱手术患者120例,年龄18~64岁,BMI 18~35 kg/m^(2),ASA分级Ⅱ或Ⅲ级,Hb浓度>100 g/L,性别不限。常规麻醉诱导与维持。S组行SmtO_(2)监测,电极片贴敷于双侧大鱼际。单侧或双侧SmtO_(2)降至基线水平70%超过60 s时,通过检查传感器位置,加速补液,使用缩血管药物,提高吸入氧浓度及输血处理。C组只贴敷电极片,不监测。于术前1 d(T_(0))、术后1 d(T_(1))和术后3 d(T_(2))时,采用QoR-15评分量表评估患者的恢复质量。记录气管拔管时间、PACU停留时间和术后住院时间。于麻醉诱导前即刻和术毕时,采集桡动脉血行血气分析,记录乳酸水平;记录术后低血压、便秘、脊神经损伤、恶心呕吐和切口感染的发生情况。结果:与C组比较,S组术毕乳酸水平降低,术后便秘、恶心呕吐和切口感染发生率降低,气管拔管时间和PACU停留时间缩短,T_(1),2时QoR-15评分升高(P<0.05)。结论:SmtO_(2)指导可改善腰椎手术患者术后早期恢复质量。

Objective To evaluate the effect of muscle oxygen saturation(SmtO_(2))guidance on the quality of early recovery after spinal surgery in the patients.Methods One hundred and twenty patients of either sex,aged 18-64 yr,with body mass index of 18-35 kg/m^(2),of American Society of Anesthesiologists Physical Status classificationⅡorⅢ,with Hb concentration>100 g/L,undergoing elective spinal surgery,were selected.Routine anesthesia induction and maintenance were performed.SmtO_(2)monitoring was carried out,and electrodes were applied to bilateral thenar in group S.When unilateral or bilateral SmtO_(2)dropped to 70%of the baseline level for more than 60 s,the sensor position was checked,fluid infusion was accelerated,vasoconstrictors was used,and the inhaled oxygen concentration was improved and blood was transfused for treatment.In group C,only electrode sheets were applied,without monitoring.The Quality of Recovery-15 scale was used to evaluate the recovery quality of patients at 1 day before operation(T_(0)),1 day after operation(T_(1))and 3 days after operation(T_(2)).The tracheal extubation time,post-anesthesia care unit stay time and postoperative length of hospital stay were recorded.Immediately before anesthesia induction and at the end of operation,arterial blood was collected for blood gas analysis,and the lactic acid level was recorded.Postoperative hypotension,constipation,spinal nerve injury,postoperative nausea and vomiting and incisional infection were recorded.Results Compared with group C,the level of postoperative lactic acid was significantly decreased,the incidence of postoperative constipation,postoperative nausea and vomiting and incisional infection was decreased,the extubation time and post-anesthesia care unit stay time were shortened,and the Quality of Recovery-15 scale score at T_(1),2 was increased in group S(P<0.05).Conclusions SmtO_(2)guidance can improve the early recovery quality of patients after lumbar surgery.