Regional oxygen saturation (rSO2) is a new method to evaluate regional oxygen supply and demand balance by near-infrared spectroscopy. It has the advantages of noninvasive, continuous and sensitive, and has been succe...Regional oxygen saturation (rSO2) is a new method to evaluate regional oxygen supply and demand balance by near-infrared spectroscopy. It has the advantages of noninvasive, continuous and sensitive, and has been successfully applied in clinical guidance. Regional oxygen saturation is usually referred to as regional cerebral oxygen saturation (rScO2) and regional tissue oxygen saturation (rStO2) depending on the site of monitoring. Initially, cerebral oxygen saturation monitoring has been used in cardiothoracic surgery and in non-cardiac surgery for elderly and critically ill patients. With the increase of clinical application, regional oxygen saturation is gradually extended to the determination of oxygen saturation in peripheral tissues, which is used to evaluate the relationship between peripheral tissue microcirculation function and the prognosis of patients. Timely detection of tissue ischemia and hypoxia and intervention can optimize the whole clinical treatment management, especially for major surgery and critically ill patients can reduce the incidence of complications during hospitalization, shorten hospitalization time, improve the prognosis of patients. This article will focus on the clinical application of cerebral oxygen saturation and tissue oxygen saturation in perioperative period.展开更多
Objective: To assess the effects of various anesthetic techniques and PaCO2 levels on cerebral oxygen supply/consumption balance during craniotomy for removal of tumors, and to explore an anesthetic technique for neur...Objective: To assess the effects of various anesthetic techniques and PaCO2 levels on cerebral oxygen supply/consumption balance during craniotomy for removal of tumors, and to explore an anesthetic technique for neurosur-gery and an appropriate degree of PaCO2 during neuroanesthesia. Methods: One hundred and fourteen patients with supratentorial tumors for elective craniotomy, ASA grade I - II , were randomly allocated to six groups. Patients were anesthetized with continuous intravenous infusion of 2% procaine 1. 0 mg · kg-1 · min-1 in Group I , inhalation of 1. 0% - 1. 5% isoflurane in Group II , and infusion of 2% procaine 0. 5 mg·kg · min-1 combined with inhalation of 0.5% -0.7% isoflurane in Group III during the period of study. The end-tidal pressure of CO2(PET CO2 ) was maintained at 4.0 kPa in these 3 groups. In Group IV, V and VI, the anesthetic technique was the same as that in Group I but the PETCO2 was adjusted to 3. 5, 4. 0 and 4. 5 kPa respectively for 60 min during which the study was performed. The radial arterial and retrograde jugular venous blood samples were obtained at the onset and the end of this study for determining jugular venous bulb oxygen saturation ( SjvO2 ) , arteriovenous oxygen content difference (AVDO2) and cerebral extraction of oxygen (CEO2). Results: In Group I and I SjvO2, AVDO2 and CEO2 remained stable. Although SjvO2 kept constant, AVDO2 and CEO2 decreased significantly (P <0. 05) in Group II. Moreover, AVDO2 and CEO2 in Group II were significantly lower than those of Group III (P<0. 05). In Group IV, 60 min after hyperventilation, SjvO2 and jugular venous oxygen content ( CjvO2 ) decreased markedly (P < 0. 01 ) while CEO2 increased significantly ( P <0.01) . In addition, SjvO2, CjvO2 and CEO2 in Group IV were significantly different from the corresponding parameters in Group V and Group VI (P <0. 05) . In view of sustained excessive hyperventilation, SjvO2 was less than 50% in 37.5% patients of Group IV. Conclusion: Anesthesia with intravenous infusion of procaine combined with isoflurane inhalation proved to be more suitable for neurosurgery than procaine intravenous anesthesia or isoflurane inhalation anesthesia alone. PaCO2 at 4.0 -4. 5 kPa in patients undergoing craniocerebral surgery during neuroanesthesia would be beneficial in both decreasing ICP and maintaining cerebral oxygen supply/consumption balance.展开更多
Objective： To explore the relationship of postoperative cognitive dysfunction （POCD） in one-lung ventilation （OLV） patients and regional cerebral oxygen saturation （rSO2）. Methods： Twenty-nine male and twenty-...Objective： To explore the relationship of postoperative cognitive dysfunction （POCD） in one-lung ventilation （OLV） patients and regional cerebral oxygen saturation （rSO2）. Methods： Twenty-nine male and twenty-one female cases of OLV received thoracic surgery, with American Standards Association （ASA） physical status being at Grades Ⅰ-Ⅲ. Neuropsychological tests were performed on the day before operation and 7 d after operation, and there was an intraoperative continuous monitoring of rSO2. The values of rSO2 before anesthesia induction （t1）, at the beginning of OLV （t2）, and at the time of OLV 30 min （t3）, OLV 60 min （t4）, the end of OLV （t5）, and the end of surgery （t6） were recorded. The intraoperative average of rSO2 （ rSO2 ）, the intraoperative minimum value of rSO2 （rSO2, rn=n）, and the reduced maximum percentage of rSO2 （rSO2, %max） when compared with the baseline value were calculated. The volume of blood loss, urine output, and the amount of fluid infusion was recorded. Results： A total of 14 patients （28%） in the 50 cases suffered from POCD. The values of mini-mental state examination （MMSE）, the digit span and the digit symbol on the 7th day after the operation for POCD in OLV patients were found to be significantly lower than those before the operation （P〈0.05）. The values of MMSE and vocabulary fluency scores were significantly lower than those in the non-POCD group （P〈0.05）. The values of rSO2 in the POCD group of OLV patients at t2 and t3 and the values of rSO2 in the non-POCD group at t2 were found to be significantly higher than those at tl （P〈0.05）. The values of rSO2, %max in the POCD group were significantly higher than those in the non-POCD group （P〈0.05）. When the value of rSO2, %max is more than 10.1%, it may act as an early warning index for cognitive function changes, Conclusions： POCD after OLV may be associated with a decline in rSO2.展开更多
Objective： To investigate the relationship between post-operative cognitive dysfunction（POCD） and regional cerebral oxygen saturation（rSO2） and β-amyloid protein（Aβ） in patients undergoing laparoscopic pancre...Objective： To investigate the relationship between post-operative cognitive dysfunction（POCD） and regional cerebral oxygen saturation（rSO2） and β-amyloid protein（Aβ） in patients undergoing laparoscopic pancreaticoduodenectomy. Methods： Fifty patients undergoing elective laparoscopic pancreaticoduodenectomy received five groups of neuropsychological tests 1 d pre-operatively and 7 d post-operatively, with continuous monitoring of rSO2 intra-operatively. Before anesthesia induction（t0）, at the beginning of laparoscopy（t1）, and at the time of pneumoperitoneum 120 min（t2）, pneumoperitoneum 240 min（t3）, pneumoperitoneum 480 min（t4）, the end of pneumoperitoneum（t5）, and 24 h after surgery, jugular venous blood was drawn respectively for the measurement of Aβ by enzyme-linked immunosorbent assay（ELISA）. Results： Twenty-one cases of the fifty patients suffered from POCD after operation. We found that the maximum percentage drop in rSO2（rSO2, %max） was significantly higher in the POCD group than in the non-POCD group. The rSO2, %max value of over 10.2% might be a potential predictor of neurocognitive injury for those patients. In the POCD group, the plasma Aβ levels after 24 h were significantly higher than those of pre-operative values（P〈0.01）. After 24 h, levels of plasma Aβ in the POCD group were significantly higher than those in the non-POCD group（P〈0.01）. Conclusions： The development of POCD in patients undergoing laparoscopic pancreaticoduodenectomy is associated with alterations of rSO2 and Aβ. Monitoring of rSO2 might be useful in the prediction of POCD, and Aβ might be used as a sensitive biochemical marker to predict the occurrence of POCD.展开更多
Background When resuscitating patients with septic shock,cerebrovascular reactivity parameters are calculated by monitoring regional cerebral oxygen saturation(rSO_(2))using near-infrared spectroscopy to determine the...Background When resuscitating patients with septic shock,cerebrovascular reactivity parameters are calculated by monitoring regional cerebral oxygen saturation(rSO_(2))using near-infrared spectroscopy to determine the optimal blood pressure.Here,we aimed to analyze the impact of cerebral autoregulation-directed optimal blood pressure management on the incidence of delirium and the prognosis of patients with septic shock.Methods This prospective randomized controlled clinical study was conducted in the Xiangya Hospital of Central South University,China.Fifty-one patients with septic shock(December 2020–May 2022)were enrolled and randomly allocated to the experimental(n=26)or control group(n=25).Using the ICM+software,we monitored the dynamic changes in rSO_(2) and mean arterial pressure(MAP)and calculated the cerebrovascular reactivity parameter tissue oxygen reactivity index to determine the optimal blood pressure to maintain normal cerebral autoregulation function during resuscitation in the experimental group.The control group was treated according to the Surviving Sepsis Campaign Guidelines.Differences in the incidence of delirium and 28-day mortality between the two groups were compared,and the risk factors were analyzed.Results The 51 patients,including 39 male and 12 female,had a mean age of(57.0±14.9)years.The incidence of delirium was 40.1%(23/51),and the 28-day mortality rate was 29.4%(15/51).The mean MAP during the first 24 h of intensive care unit(ICU)admission was higher([84.5±12.2]mmHg vs.[77.4±11.8]mmHg,P=0.040),and the incidence of delirium was lower(30.8%vs.60.0%,P=0.036)in the experimental group than in the control group.The use of cerebral autoregulation-directed optimal blood pressure(odds ratio[OR]=0.090,95%confidence interval[CI]:0.009 to 0.923,P=0.043)and length of ICU stay(OR=1.473,95%CI:1.093 to 1.985,P=0.011)were risk factors for delirium during septic shock.Vasoactive drug dose(OR=8.445,95%CI:1.26 to 56.576,P=0.028)and partial pressure of oxygen(PaO_(2))(OR=0.958,95%CI:0.921 to 0.996,P=0.032)were the risk factors for 28-day mortality.Conclusions The use of cerebral autoregulation-directed optimal blood pressure management during shock resuscitation reduces the incidence of delirium in patients with septic shock.展开更多
BACKGROUND Colon cancer presents a substantial risk to the well-being of elderly people worldwide.With advancements in medical technology,surgical treatment has become the primary approach for managing colon cancer pa...BACKGROUND Colon cancer presents a substantial risk to the well-being of elderly people worldwide.With advancements in medical technology,surgical treatment has become the primary approach for managing colon cancer patients.However,due to age-related physiological changes,especially a decline in cognitive function,older patients are more susceptible to the effects of surgery and anesthesia,increasing the relative risk of postoperative cognitive dysfunction(POCD).There-fore,in the surgical treatment of elderly patients with colon cancer,it is of pa-ramount importance to select an appropriate anesthetic approach to reduce the occurrence of POCD,protect brain function,and improve surgical success rates.METHODS One hundred and seventeen patients with colon cancer who underwent elective surgery under general anesthesia were selected and divided into two groups:A and B.Group A received Dex before anesthesia induction,and B group received an equivalent amount of normal saline.Changes in the mini-mental state exami-nation,regional cerebral oxygen saturation(rSO2),bispectral index,glucose uptake rate(GluER),lactate production rate(LacPR),serum S100βand neuron-specific enolase(NSE),POCD,and adverse anesthesia reactions were compared between the two groups.RESULTS Surgical duration,duration of anesthesia,and intraoperative blood loss were comparable between the two groups(P>0.05).The overall dosage of anesthetic drugs used in group A,including propofol and remifentanil,was significantly lower than that used in group B(P<0.05).Group A exhibited higher rSO2 values at the time of endotracheal intubation,30 min after the start of surgery,and immediately after extubation,higher GluER values and lower LacPR values at the time of endotra-cheal intubation,30 min after the start of surgery,immediately after extubation,and 5 min after extubation(P<0.05).Group A exhibited lower levels of serum S100βand NSE 24 h postoperatively and a lower incidence of cognitive dysfunction on the 1st and 5th postoperative days(P<0.05).CONCLUSION The use of Dex in elderly patients undergoing radical colon cancer surgery helps maintain rSO2 Levels and reduce cerebral metabolic levels and the incidence of anesthesia-and surgery-induced cognitive dysfunction.展开更多
文摘Regional oxygen saturation (rSO2) is a new method to evaluate regional oxygen supply and demand balance by near-infrared spectroscopy. It has the advantages of noninvasive, continuous and sensitive, and has been successfully applied in clinical guidance. Regional oxygen saturation is usually referred to as regional cerebral oxygen saturation (rScO2) and regional tissue oxygen saturation (rStO2) depending on the site of monitoring. Initially, cerebral oxygen saturation monitoring has been used in cardiothoracic surgery and in non-cardiac surgery for elderly and critically ill patients. With the increase of clinical application, regional oxygen saturation is gradually extended to the determination of oxygen saturation in peripheral tissues, which is used to evaluate the relationship between peripheral tissue microcirculation function and the prognosis of patients. Timely detection of tissue ischemia and hypoxia and intervention can optimize the whole clinical treatment management, especially for major surgery and critically ill patients can reduce the incidence of complications during hospitalization, shorten hospitalization time, improve the prognosis of patients. This article will focus on the clinical application of cerebral oxygen saturation and tissue oxygen saturation in perioperative period.
基金Supported by the"Tenth five-year-plan"Medical Science Foundation of PLA(NO.01M118 to Dr.CHEN).
文摘Objective: To assess the effects of various anesthetic techniques and PaCO2 levels on cerebral oxygen supply/consumption balance during craniotomy for removal of tumors, and to explore an anesthetic technique for neurosur-gery and an appropriate degree of PaCO2 during neuroanesthesia. Methods: One hundred and fourteen patients with supratentorial tumors for elective craniotomy, ASA grade I - II , were randomly allocated to six groups. Patients were anesthetized with continuous intravenous infusion of 2% procaine 1. 0 mg · kg-1 · min-1 in Group I , inhalation of 1. 0% - 1. 5% isoflurane in Group II , and infusion of 2% procaine 0. 5 mg·kg · min-1 combined with inhalation of 0.5% -0.7% isoflurane in Group III during the period of study. The end-tidal pressure of CO2(PET CO2 ) was maintained at 4.0 kPa in these 3 groups. In Group IV, V and VI, the anesthetic technique was the same as that in Group I but the PETCO2 was adjusted to 3. 5, 4. 0 and 4. 5 kPa respectively for 60 min during which the study was performed. The radial arterial and retrograde jugular venous blood samples were obtained at the onset and the end of this study for determining jugular venous bulb oxygen saturation ( SjvO2 ) , arteriovenous oxygen content difference (AVDO2) and cerebral extraction of oxygen (CEO2). Results: In Group I and I SjvO2, AVDO2 and CEO2 remained stable. Although SjvO2 kept constant, AVDO2 and CEO2 decreased significantly (P <0. 05) in Group II. Moreover, AVDO2 and CEO2 in Group II were significantly lower than those of Group III (P<0. 05). In Group IV, 60 min after hyperventilation, SjvO2 and jugular venous oxygen content ( CjvO2 ) decreased markedly (P < 0. 01 ) while CEO2 increased significantly ( P <0.01) . In addition, SjvO2, CjvO2 and CEO2 in Group IV were significantly different from the corresponding parameters in Group V and Group VI (P <0. 05) . In view of sustained excessive hyperventilation, SjvO2 was less than 50% in 37.5% patients of Group IV. Conclusion: Anesthesia with intravenous infusion of procaine combined with isoflurane inhalation proved to be more suitable for neurosurgery than procaine intravenous anesthesia or isoflurane inhalation anesthesia alone. PaCO2 at 4.0 -4. 5 kPa in patients undergoing craniocerebral surgery during neuroanesthesia would be beneficial in both decreasing ICP and maintaining cerebral oxygen supply/consumption balance.
基金supported by the Foundation of Shandong Science and Technology Project(No.2011YD18070),China
文摘Objective： To explore the relationship of postoperative cognitive dysfunction （POCD） in one-lung ventilation （OLV） patients and regional cerebral oxygen saturation （rSO2）. Methods： Twenty-nine male and twenty-one female cases of OLV received thoracic surgery, with American Standards Association （ASA） physical status being at Grades Ⅰ-Ⅲ. Neuropsychological tests were performed on the day before operation and 7 d after operation, and there was an intraoperative continuous monitoring of rSO2. The values of rSO2 before anesthesia induction （t1）, at the beginning of OLV （t2）, and at the time of OLV 30 min （t3）, OLV 60 min （t4）, the end of OLV （t5）, and the end of surgery （t6） were recorded. The intraoperative average of rSO2 （ rSO2 ）, the intraoperative minimum value of rSO2 （rSO2, rn=n）, and the reduced maximum percentage of rSO2 （rSO2, %max） when compared with the baseline value were calculated. The volume of blood loss, urine output, and the amount of fluid infusion was recorded. Results： A total of 14 patients （28%） in the 50 cases suffered from POCD. The values of mini-mental state examination （MMSE）, the digit span and the digit symbol on the 7th day after the operation for POCD in OLV patients were found to be significantly lower than those before the operation （P〈0.05）. The values of MMSE and vocabulary fluency scores were significantly lower than those in the non-POCD group （P〈0.05）. The values of rSO2 in the POCD group of OLV patients at t2 and t3 and the values of rSO2 in the non-POCD group at t2 were found to be significantly higher than those at tl （P〈0.05）. The values of rSO2, %max in the POCD group were significantly higher than those in the non-POCD group （P〈0.05）. When the value of rSO2, %max is more than 10.1%, it may act as an early warning index for cognitive function changes, Conclusions： POCD after OLV may be associated with a decline in rSO2.
基金Project supported by the Shandong Science and Technology Development Project(No.2011YD18070),China
文摘Objective： To investigate the relationship between post-operative cognitive dysfunction（POCD） and regional cerebral oxygen saturation（rSO2） and β-amyloid protein（Aβ） in patients undergoing laparoscopic pancreaticoduodenectomy. Methods： Fifty patients undergoing elective laparoscopic pancreaticoduodenectomy received five groups of neuropsychological tests 1 d pre-operatively and 7 d post-operatively, with continuous monitoring of rSO2 intra-operatively. Before anesthesia induction（t0）, at the beginning of laparoscopy（t1）, and at the time of pneumoperitoneum 120 min（t2）, pneumoperitoneum 240 min（t3）, pneumoperitoneum 480 min（t4）, the end of pneumoperitoneum（t5）, and 24 h after surgery, jugular venous blood was drawn respectively for the measurement of Aβ by enzyme-linked immunosorbent assay（ELISA）. Results： Twenty-one cases of the fifty patients suffered from POCD after operation. We found that the maximum percentage drop in rSO2（rSO2, %max） was significantly higher in the POCD group than in the non-POCD group. The rSO2, %max value of over 10.2% might be a potential predictor of neurocognitive injury for those patients. In the POCD group, the plasma Aβ levels after 24 h were significantly higher than those of pre-operative values（P〈0.01）. After 24 h, levels of plasma Aβ in the POCD group were significantly higher than those in the non-POCD group（P〈0.01）. Conclusions： The development of POCD in patients undergoing laparoscopic pancreaticoduodenectomy is associated with alterations of rSO2 and Aβ. Monitoring of rSO2 might be useful in the prediction of POCD, and Aβ might be used as a sensitive biochemical marker to predict the occurrence of POCD.
基金supported by the National Natural Science Foundation of China(82372199)National Natural Science Foundation of China(81901264,81974285)Clinical Medical Technology Innovation Guidance Project of Hunan Science and Technology Department(2021SK53803).
文摘Background When resuscitating patients with septic shock,cerebrovascular reactivity parameters are calculated by monitoring regional cerebral oxygen saturation(rSO_(2))using near-infrared spectroscopy to determine the optimal blood pressure.Here,we aimed to analyze the impact of cerebral autoregulation-directed optimal blood pressure management on the incidence of delirium and the prognosis of patients with septic shock.Methods This prospective randomized controlled clinical study was conducted in the Xiangya Hospital of Central South University,China.Fifty-one patients with septic shock(December 2020–May 2022)were enrolled and randomly allocated to the experimental(n=26)or control group(n=25).Using the ICM+software,we monitored the dynamic changes in rSO_(2) and mean arterial pressure(MAP)and calculated the cerebrovascular reactivity parameter tissue oxygen reactivity index to determine the optimal blood pressure to maintain normal cerebral autoregulation function during resuscitation in the experimental group.The control group was treated according to the Surviving Sepsis Campaign Guidelines.Differences in the incidence of delirium and 28-day mortality between the two groups were compared,and the risk factors were analyzed.Results The 51 patients,including 39 male and 12 female,had a mean age of(57.0±14.9)years.The incidence of delirium was 40.1%(23/51),and the 28-day mortality rate was 29.4%(15/51).The mean MAP during the first 24 h of intensive care unit(ICU)admission was higher([84.5±12.2]mmHg vs.[77.4±11.8]mmHg,P=0.040),and the incidence of delirium was lower(30.8%vs.60.0%,P=0.036)in the experimental group than in the control group.The use of cerebral autoregulation-directed optimal blood pressure(odds ratio[OR]=0.090,95%confidence interval[CI]:0.009 to 0.923,P=0.043)and length of ICU stay(OR=1.473,95%CI:1.093 to 1.985,P=0.011)were risk factors for delirium during septic shock.Vasoactive drug dose(OR=8.445,95%CI:1.26 to 56.576,P=0.028)and partial pressure of oxygen(PaO_(2))(OR=0.958,95%CI:0.921 to 0.996,P=0.032)were the risk factors for 28-day mortality.Conclusions The use of cerebral autoregulation-directed optimal blood pressure management during shock resuscitation reduces the incidence of delirium in patients with septic shock.
文摘BACKGROUND Colon cancer presents a substantial risk to the well-being of elderly people worldwide.With advancements in medical technology,surgical treatment has become the primary approach for managing colon cancer patients.However,due to age-related physiological changes,especially a decline in cognitive function,older patients are more susceptible to the effects of surgery and anesthesia,increasing the relative risk of postoperative cognitive dysfunction(POCD).There-fore,in the surgical treatment of elderly patients with colon cancer,it is of pa-ramount importance to select an appropriate anesthetic approach to reduce the occurrence of POCD,protect brain function,and improve surgical success rates.METHODS One hundred and seventeen patients with colon cancer who underwent elective surgery under general anesthesia were selected and divided into two groups:A and B.Group A received Dex before anesthesia induction,and B group received an equivalent amount of normal saline.Changes in the mini-mental state exami-nation,regional cerebral oxygen saturation(rSO2),bispectral index,glucose uptake rate(GluER),lactate production rate(LacPR),serum S100βand neuron-specific enolase(NSE),POCD,and adverse anesthesia reactions were compared between the two groups.RESULTS Surgical duration,duration of anesthesia,and intraoperative blood loss were comparable between the two groups(P>0.05).The overall dosage of anesthetic drugs used in group A,including propofol and remifentanil,was significantly lower than that used in group B(P<0.05).Group A exhibited higher rSO2 values at the time of endotracheal intubation,30 min after the start of surgery,and immediately after extubation,higher GluER values and lower LacPR values at the time of endotra-cheal intubation,30 min after the start of surgery,immediately after extubation,and 5 min after extubation(P<0.05).Group A exhibited lower levels of serum S100βand NSE 24 h postoperatively and a lower incidence of cognitive dysfunction on the 1st and 5th postoperative days(P<0.05).CONCLUSION The use of Dex in elderly patients undergoing radical colon cancer surgery helps maintain rSO2 Levels and reduce cerebral metabolic levels and the incidence of anesthesia-and surgery-induced cognitive dysfunction.
