高血压脑出血手术患者术中脑氧饱和度变化对术后早期再出血的影响

Effect of cerebral oxygen saturation change during surgery on early postoperative rebleeding in patients with hypertensive intracerebral hemorrhage

目的:探究高血压脑出血手术患者术中脑氧饱和度(rScO_(2))变化对术后早期再出血的影响。方法:本研究采用前瞻性研究方法,纳入2019年4月至2022年4月郑州大学第五附属医院收治的380例行手术治疗的高血压脑出血患者为研究对象,所有患者均接受术中ScO_(2)持续监测,依据患者术后早期(24 h内)再出血发生情况分为再出血组(41例)和非再出血组(339例)。记录两组麻醉诱导时(T0)、气管插管后5 min(T1)、手术开始后60 min(T2)、术毕带管自主呼吸时(T3)rScO_(2)水平,以患者上述时点rScO_(2)标准差反映患者术中rScO_(2)变化率,分析高血压脑出血患者术中rScO_(2)变化率与术后早期再出血的关系、术中rScO_(2)变化对高血压脑出血术后早期再出血的预测价值。结果:T0、T1时,两组rScO_(2)水平比较差异未见统计学意义(P>0.05);T2时,两组rScO_(2)水平均较T0时降低,且再出血组rScO_(2)低于非再出血组(P<0.05);T3时,两组rScO_(2)水平均较T0时提高,且非再出血组rScO_(2)高于再出血组(P<0.05)。再出血组手术期间rScO_(2)标准差(2.73±1.56)小于非再出血组手术期间rScO_(2)标准差(3.78±0.96),差异有统计学意义(t=3.92,P<0.001)。绘制受试者工作特征曲线结果显示,术中rScO_(2)标准差预测高血压脑出血患者术后早期再出血的曲线下面积均≥0.7,具有一定的预测价值。结论:高血压脑出血患者手术治疗后其rScO_(2)整体呈上升趋势,术中rScO_(2)提升程度低的患者较rScO_(2)提升程度高的患者更易并发术后早期再出血,实时监测患者术中rScO_(2)情况可评估患者术后早期再出血风险。

Objective To investigate the influence of regional cerebral oxygen saturation(rScO_(2))change during surgery on early postoperative rebleeding in patients with hypertensive intracerebral hemorrhage.MethodsThe study was a prospective trial.A total of 380 patients with hypertensive intracerebral hemorrhage who underwent surgical treatment in the Fifth Affiliated Hospital of Zhengzhou University from April 2019 to April 2022 were included as the study objects.All patients received continuous monitoring of rScO_(2),and were divided into rebleeding group(41 cases)and non rebleeding group(339 cases)according to the occurrence of rebleeding in the early postoperative period(within 24 hours).The rScO_(2) levels at anesthesia induction(T0),5 min after tracheal intubation(T1),60 min after surgery(T2),and at the end of surgery(T3)of the two groups were recorded.The rScO_(2) standard deviation of patients at the above time points was used to reflect the rScO_(2) change rate during surgery.The relationship between rScO_(2) change rate during surgery and early postoperative rebleeding in patients with hypertensive intracerebral hemorrhage,and the predictive value of rScO_(2) change during surgery for early postoperative rebleeding in patients with hypertensive intracerebral hemorrhage were analyzed.ResultsAt T0 and T1,there was no significant difference between the two groups in rScO_(2) level(P>0.05).At T2,the rScO_(2) level in both groups were lower than those at T0,and the rScO_(2) level in the rebleeding group was lower than that in the non rebleeding group(P<0.05).At T3,the rScO_(2) level in the two groups were higher than those at T0,and the rScO_(2) level in the non rebleeding group was higher than that in the rebleeding group(P<0.05).The standard deviation of rScO_(2) during operation in the rebleeding group(2.73±1.56)was less than that in the non rebleeding group(3.78±0.96),the difference was statistically significant(t=3.92,P<0.001).Receiver operating characteristic curve showed that the area under the curve of the standard deviation of intraoperative rScO_(2) in predicting early postoperative rebleeding in patients with hypertensive intracerebral hemorrhage was≥0.7,which had certain predictive value.ConclusionsAfter the surgical treatment of hypertensive intracerebral hemorrhage,the overall trend of rScO_(2) is rising.Patients with low rScO_(2) elevation during the operation are more likely to have early postoperative rebleeding than patients with high rScO_(2) elevation.Real time monitoring of rScO_(2) during the operation can be used to assess the risk of early postoperative rebleeding.