Objective: To evaluate the effects of various degrees of hyperventilation on balance of cerebral oxygensupply and consumption during intravenous general anesthesia with jugular venous oxygen saturation monitoringMetbo...Objective: To evaluate the effects of various degrees of hyperventilation on balance of cerebral oxygensupply and consumption during intravenous general anesthesia with jugular venous oxygen saturation monitoringMetbods: Sixty-six patients with supratentorial tumor undergoing intravenous general anesthesia for brain surgerywere randomly divided into three groups. In group Ⅰ, Ⅱ and Ⅲ, end-tidal pressure of Co2(PETCO2) were maintained at 3. 5, 4. 0 and 4. 5 kPa respectively. Radial arterial blood samples and jugular bulb blood samples weretaken synchronously at 60 min after hyperventilation to measure jugular venous oxygen saturation (SjvO2), cerebral extraction of oxygen (CEO2) and cerebral arteriovenous oxygen content difference (AVDO2) were calculatedResults: In group Ⅰ after hyperventilation, SjvO, and jugular venous oxygen content (CjvO2) were decreasedmarkedly while CEO2 was increased significantly, which was different significantly compared with the baseline andcorresponding value in group Ⅱ and Ⅲ (P<0. 05). After hyperventilation in group, and, SjvO2 CjvO2, CEO2and AVDO, remained unchanged. Conclusion: This study shows that sustained excessive hyperventilation (PETCO23.5 kPa) may account for the less favorable cerebral oxygen supply and consumption balance and maintained PETCO, at 4. 0~4. 5 kPa was optimal hyperventilation for brain surgery anesthesia.展开更多
目的:观察Narcotrend指数联合血氧饱和度(SjvO2)监测对老年患者腹腔镜手术后认知功能评定的影响。方法:选取ASA分级Ⅰ-Ⅱ级、年龄>60岁行腹腔镜手术患者90例,随机分成3组(N1、N2、N3),3组患者采用相同的监测、麻醉诱导和维持用药、...目的:观察Narcotrend指数联合血氧饱和度(SjvO2)监测对老年患者腹腔镜手术后认知功能评定的影响。方法:选取ASA分级Ⅰ-Ⅱ级、年龄>60岁行腹腔镜手术患者90例,随机分成3组(N1、N2、N3),3组患者采用相同的监测、麻醉诱导和维持用药、复苏方法,床旁超声引导下行右颈内静脉入路逆行穿刺置管到位,采血检测颈静脉球部SjvO2,术中使3个组Narcotrend指数维持至预设的3种水平(N1=60±3、N2=45±3、N3=30±3),各组每隔20 min分别记录在预设区间内平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SPO2)、多巴胺的总用量、麻醉深度的Narcotrend指数(NI)、颈静脉球部SjvO2、分别术前1 d、术后1 d、3 d、7 d用简易精神状态评价量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分。结果:与N1组比较,N2组、N3组T1-T4时点HR下降(P<0.05),多巴胺总用量增加(P<0.05);与N1、N2组比较,N3组T1-T4时点SjvO2下降(P<0.05);与术前1 d比较,N1组术后1 d MMSE评分、MoCA评分下降(P<0.05),N3组术后1 d、3 d、7 d MMSE评分、MoCA评分下降(P<0.05);与N2组比较,N1组术后1 d MMSE评分、MoCA评分下降(P<0.05),N3组术后1 d、3 d、7 d MMSE评分、MoCA评分下降(P<0.05)。结论:联合Narcotrend和SjvO2监测发现麻醉深度过浅或过深、SjvO2下降时会出现术后早期认知功能障碍(POCD),术中应维持合适的麻醉深度,避免SjvO2下降,能有效预防早期POCD。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
To observe the effects of sevoflurane.isoflurane’propofol and procaine on jugularvenous oxyhemoglobin saturation(SjO, ) andcerebral oxygen saturati0n (YSO,) ’forty pa-tients scheduled to undergo abdominal oper-ation...To observe the effects of sevoflurane.isoflurane’propofol and procaine on jugularvenous oxyhemoglobin saturation(SjO, ) andcerebral oxygen saturati0n (YSO,) ’forty pa-tients scheduled to undergo abdominal oper-ations, AsA graded I to 1, age 29 to 52years, were randomly divicded into fourgroups: inhalation sevoflurane anesthesia(group I i n = l0 ), inhalation isofluraneanesthesia (gr0up I; n = 1O ), intravenouspropofol anesthesia (group N 1 n = lO), in-travenous procaine balance anesthesia(group IV; n = 10), ln condition that thelevel of Pet CO, was kept in the normalrange by a ventilator, SjO,, was measuredfrom draw jugular ven0us blood and YSO,was measured by Invos 3lOO cerebraloximeter before and after induction and du-ing maintenance 0f anesthesia, meanwhilethe mean artery pressure (MAP ) ’heart rate(HR )’ temperature (T ) and saturation ofpulse oxygen (SPO, ) were monitored. Itwas found that Sj0, and YSO, were signifi-cantly increased before and after inductionand during maintenance of anesthesia ingroup I ` 1 and m, The results shows thatSjO, and YSO, reflect 0bjectively effects ofanesthetics on balance between supply anddemand of cerebral oxygen if the levels ofT; Pet CO,’HR’MAPand SpO, are kept inthe certain range.展开更多
文摘Objective: To evaluate the effects of various degrees of hyperventilation on balance of cerebral oxygensupply and consumption during intravenous general anesthesia with jugular venous oxygen saturation monitoringMetbods: Sixty-six patients with supratentorial tumor undergoing intravenous general anesthesia for brain surgerywere randomly divided into three groups. In group Ⅰ, Ⅱ and Ⅲ, end-tidal pressure of Co2(PETCO2) were maintained at 3. 5, 4. 0 and 4. 5 kPa respectively. Radial arterial blood samples and jugular bulb blood samples weretaken synchronously at 60 min after hyperventilation to measure jugular venous oxygen saturation (SjvO2), cerebral extraction of oxygen (CEO2) and cerebral arteriovenous oxygen content difference (AVDO2) were calculatedResults: In group Ⅰ after hyperventilation, SjvO, and jugular venous oxygen content (CjvO2) were decreasedmarkedly while CEO2 was increased significantly, which was different significantly compared with the baseline andcorresponding value in group Ⅱ and Ⅲ (P<0. 05). After hyperventilation in group, and, SjvO2 CjvO2, CEO2and AVDO, remained unchanged. Conclusion: This study shows that sustained excessive hyperventilation (PETCO23.5 kPa) may account for the less favorable cerebral oxygen supply and consumption balance and maintained PETCO, at 4. 0~4. 5 kPa was optimal hyperventilation for brain surgery anesthesia.
文摘目的:观察Narcotrend指数联合血氧饱和度(SjvO2)监测对老年患者腹腔镜手术后认知功能评定的影响。方法:选取ASA分级Ⅰ-Ⅱ级、年龄>60岁行腹腔镜手术患者90例,随机分成3组(N1、N2、N3),3组患者采用相同的监测、麻醉诱导和维持用药、复苏方法,床旁超声引导下行右颈内静脉入路逆行穿刺置管到位,采血检测颈静脉球部SjvO2,术中使3个组Narcotrend指数维持至预设的3种水平(N1=60±3、N2=45±3、N3=30±3),各组每隔20 min分别记录在预设区间内平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SPO2)、多巴胺的总用量、麻醉深度的Narcotrend指数(NI)、颈静脉球部SjvO2、分别术前1 d、术后1 d、3 d、7 d用简易精神状态评价量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分。结果:与N1组比较,N2组、N3组T1-T4时点HR下降(P<0.05),多巴胺总用量增加(P<0.05);与N1、N2组比较,N3组T1-T4时点SjvO2下降(P<0.05);与术前1 d比较,N1组术后1 d MMSE评分、MoCA评分下降(P<0.05),N3组术后1 d、3 d、7 d MMSE评分、MoCA评分下降(P<0.05);与N2组比较,N1组术后1 d MMSE评分、MoCA评分下降(P<0.05),N3组术后1 d、3 d、7 d MMSE评分、MoCA评分下降(P<0.05)。结论:联合Narcotrend和SjvO2监测发现麻醉深度过浅或过深、SjvO2下降时会出现术后早期认知功能障碍(POCD),术中应维持合适的麻醉深度,避免SjvO2下降,能有效预防早期POCD。
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.
文摘目的探讨半坐位开颅患者无创脑氧饱和度(cerebral tissue oxygen saturation,SctO_(2))与颈静脉球部氧饱和度(jugular venous oxygen saturation,SjvO_(2))的影响因素。方法选取2018年4月至2020年5月首都医科大学宣武医院行半坐位听神经瘤手术的患者30例。采用Fore-sight近红外光仪监测无创SctO_(2),通过术侧颈静脉球部置管采集血液标本测定SjvO_(2)。记录半坐位切皮(T0)、硬脑膜剪开后30 min(T1)及肿瘤切除后(T2)双侧无创SctO_(2)及术侧SjvO_(2)、MAP、中心静脉压(central venous pressure,CVP)和颈静脉球部压力(jugular bulb pressure,JBP)。同时采集动脉血测定PaCO_(2)、PaO_(2),采集颈静脉球部血液标本测定颈静脉球部二氧化碳分压(pressure of carbon dioxide in the jugular venous,PjvCO_(2))、颈静脉球部氧分压(pressure of oxygen in the jugular venous,PjvO_(2))、红细胞比容(hematocrit,Hct)及乳酸(lactic acid,Lac),纳入MAP、CVP、JBP、PaCO_(2)、PaO_(2),PjvCO_(2)、PjvO_(2)、Hct及Lac进行SctO_(2)与SjvO_(2)影响因素的多元线性回归分析。结果PjvO_(2)、PjvCO_(2)、PaCO_(2)、JBP和Hct对SjvO_(2)的影响有统计学意义(P<0.05),调整后的R2=0.845;CVP、MAP及PaCO_(2)对术侧SctO_(2)的影响有统计学意义(P=0.000),调整后的R2=0.371。结论半坐位开颅患者采用SctO_(2)和SjvO_(2)监测时需考虑不同的影响因素,采取相应措施有效改善脑氧供需平衡状态。
文摘To observe the effects of sevoflurane.isoflurane’propofol and procaine on jugularvenous oxyhemoglobin saturation(SjO, ) andcerebral oxygen saturati0n (YSO,) ’forty pa-tients scheduled to undergo abdominal oper-ations, AsA graded I to 1, age 29 to 52years, were randomly divicded into fourgroups: inhalation sevoflurane anesthesia(group I i n = l0 ), inhalation isofluraneanesthesia (gr0up I; n = 1O ), intravenouspropofol anesthesia (group N 1 n = lO), in-travenous procaine balance anesthesia(group IV; n = 10), ln condition that thelevel of Pet CO, was kept in the normalrange by a ventilator, SjO,, was measuredfrom draw jugular ven0us blood and YSO,was measured by Invos 3lOO cerebraloximeter before and after induction and du-ing maintenance 0f anesthesia, meanwhilethe mean artery pressure (MAP ) ’heart rate(HR )’ temperature (T ) and saturation ofpulse oxygen (SPO, ) were monitored. Itwas found that Sj0, and YSO, were signifi-cantly increased before and after inductionand during maintenance of anesthesia ingroup I ` 1 and m, The results shows thatSjO, and YSO, reflect 0bjectively effects ofanesthetics on balance between supply anddemand of cerebral oxygen if the levels ofT; Pet CO,’HR’MAPand SpO, are kept inthe certain range.
