允许性高碳酸血症对沙滩椅位肩关节镜手术肥胖患者的影响

Effect of permissive hypercapnia on obese patients undergoing shoulder arthroscopic surgery with beach chair position

目的研究允许性高碳酸血症(permissive hypercapnia,PHC)对沙滩椅位(beach chair position,BCP)肩关节镜手术肥胖患者的影响。方法纳入河南省洛阳正骨医院关节外科2019年1月至2021年1月接受肩关节镜手术治疗、体质量指数≥28 kg/m2患者67例,采用随机数字表法分为观察组和对照组。观察组术中维持呼气末二氧化碳分压(partial pressure of endtidal carbon dioxide,P_(et)CO_(2))45~50 mmHg,对照组P_(et)CO_(2)为30~35 mmHg。观察时间点分别为麻醉诱导前(T0)、改BCP后10min(T1)、控制性降压10min(T2)、变更通气策略后10min(T3)、术后改为平卧位后10 min(T4)。比较两组平均动脉压(mean arterial pressure,MAP)、脑氧饱和度(cerebral oxygen saturation,rSO_(2))、低血压、谵妄、rSO_(2)下降事件(cerebral oxygen saturation descent event,CDE),及术后D1、D3简易精神状态检查(mini-mental state examination,MMSE)评分。结果两组T1、T2、T3的MAP均低于T0,差异均有统计学意义(P<0.05)。两组T2的rSO_(2)水平降幅分别为16.84%、21.51%,较T0差异均有统计学意义(P<0.05);观察组T3、T4的rSO_(2)水平均高于对照组,差异均有统计学意义(P<0.05)。观察组MMSE评分显著高于对照组,差异有统计学意义(P<0.05)。结论PHC可保证肥胖患者BCP肩关节镜手术过程中rSO_(2)水平稳定,降低术后谵妄等并发症发生风险。

Objective To investigate the influence of permissive hypercapnia(PHC)on obese patients undergoing shoulder arthroscopic surgery with beach chair position(BCP).Methods Sixty-seven patients with body mass index≥28 kg/m2 who received shoulder arthroscopic surgery in the Department of joint surgery,Luoyang orthopedic-traumatological hospital of Henan province from January 2019 to January 2021 were enrolled and randomly divided into observation group and control group by random number table method.The partial pressure of end-tidal carbon dioxide(P_(et)CO_(2))was 45-50 mmHg in the observation group and 30-35 mmHg in the control group.The observation time points were before anesthesia induction(T0),10 min after BCP modification(T1),10 min after controlled hypotension(T2),10 min after ventilation strategy modification(T3),and 10 min after supine position modification(T4).Mean arterial pressure(MAP),cerebral oxygen saturation(rSO_(2)),hypotension,delirium,rSO_(2)descent event(CDE),and postoperative D1 and D3 minimental state examination(MMSE)score were compared between the two groups.Results MAP of the two groups at T1,T2 and T3 were lower than those at T0,and the differences were statistically significant(P<0.05).RSO2 levels at T2 in the two groups decreased by 16.84%and 21.51%,respectively,and there were statistically significant differences compared with T0(P<0.05).RSO2 levels at T3 and T4 in observation group were higher than those in control group,and the differences were statistically significant(P<0.05).MMSE score of observation group was significantly higher than that of control group,and the difference was statistically significant(P<0.05).Conclusion PHC can ensure stable rSO_(2)level in obese patients during shoulder arthroscopic surgery with BCP and reduce the risk of postoperative delirium and other complications.