手术室代理决策对开颅手术患者神经功能恢复情况的影响

Effect of agency decision in operating room on the recovery of neurological function in patients undergoing craniotomy

目的研究手术室代理决策对开颅手术患者脑氧代谢、脑血流动力学及神经功能的影响。方法选择2019年1月至2021年12月于我院行开颅手术的患者98例,依据是否同意手术室代理决策分为试验组与对照组各49例,对照组行常规代理决策,试验组行手术室代理决策。观察两组术中出血量、手术时间及住院时间等手术相关指标;术前及术后1 d收缩期峰值流速、舒张末期血流速度等脑血流动力学指标;颈内静脉血氧含量(CjvO_(2))、颈内静脉血氧饱和度(SjvO_(2))及脑氧摄取率(CERO_(2))等脑氧代谢指标及神经功能;以及术后并发症、医疗纠纷发生情况。结果试验组术中出血量、手术时间及住院时间均少于对照组(P<0.05);术后1 d,试验组收缩期峰值流速大于对照组,舒张末期血流速度小于对照组(P<0.05);术后7 d,试验组CjvO_(2)、SjvO_(2)及CERO_(2)均大于对照组,NIHSS评分小于对照组(P<0.05);试验组术后并发症、医疗纠纷发生率均少于对照组(P<0.05)。结论手术室代理决策可有效缩短手术时间,减少患者创伤,改善患者血流动力学、脑氧代谢及神经功能,减少医疗纠纷。

Objective To investigate the effects of surrogate decision in operating rooms on cerebral oxygen metabolism,cerebral hemodynamics and neurologic function in patients undergoing craniotomy.Methods A total of 98 patients who underwent craniotomy in our hospital from January 2019 to December 2021 were selected.The patients were divided into an experimental group(n=49)and a control group(n=49)according to whether they agreed with the surrogate decision in operating rooms.The control group received routine surrogate decision.The experimental group received surrogate decision in operating rooms.The intraoperative blood loss,operation time,hospital stay and other surgery-related indexes were observed.The cerebral hemodynamic indexes such as peak systolic flow velocity and end-diastolic flow velocity before and after 1 day of operation,the cerebral oxygen metabolism indexes such as content O_(2)of jugular vein(CjvO_(2)),jugular venous blood oxygen saturation(SjvO_(2)),and cerebral O_(2)extraction rate(CERO_(2))as well as neurological function before and after 7 days of operation were also observed.The occurrence of postoperative complications and medical disputes was compared between the two groups.Results The intraoperative blood loss,operation time and hospital stay in the experimental group were lower or shorter than those in the control group(P<0.05).After 1 day of operation,the peak systolic flow velocity of the experimental group was higher than that of the control group,and the end-diastolic flow velocity of the experimental group was lower than that of the control group(P<0.05).After 7 days of operation,the CjvO_(2),SjvO_(2)and CERO_(2)of the experimental group were higher than those of the control group,and the NIHSS score of the experimental group was lower than that of the control group(P<0.05).The incidence of postoperative complications and medical disputes in the experimental group were lower than those in the control group(P<0.05).Conclusions The surrogate decision in operating rooms can effectively shorten the operation time and reduce the trauma of the patients.It can improve the hemodynamics,cerebral oxygen metabolism and neurologic function of the patients.It also reduces the medical disputes.