【摘要】：目的： 觀察擇期神經(jīng)外科手術(shù)患者在我院手術(shù)室條件下其體溫與腦氧代謝的變化,探討兩者之間的相關(guān)性,為神經(jīng)外科手術(shù)術(shù)中是否采用低溫進行腦保護提供依據(jù)。 方法： 收集擇期行顱內(nèi)占位手術(shù)患者20例,入手術(shù)室后常規(guī)保溫,監(jiān)測BP、HR、ECG、SPO2。麻醉誘導(dǎo)氣管內(nèi)插管后,經(jīng)橈動脈置入動脈測壓管；經(jīng)右側(cè)頸內(nèi)靜脈逆行置入雙腔靜脈導(dǎo)管,確保前端位于頸靜脈竇部(第二頸椎至顱骨之間)；經(jīng)鼻腔置入鼻咽溫探頭至咽腔部。于氣管插管后即刻(t1)、硬腦膜切開時(t2)、取瘤1小時(t3)、硬腦膜縫合時(t4)、拔管后10分鐘(t5),記錄其體溫并同步采取橈動脈及頸內(nèi)靜脈球部血液作血氣分析：記錄二者血氧分壓、氧飽和度、血紅蛋白含量等,依據(jù)FICK公式計算頸內(nèi)動脈、頸內(nèi)靜脈血氧含量及差值、腦氧攝取率。 結(jié)果： 1.20例患者在術(shù)中均有頸靜脈球部血氧飽和度上升、頸內(nèi)動靜脈血氧含量差及腦氧攝取率下降的情況出現(xiàn),而其中有18例在術(shù)中出現(xiàn)了體溫下降(34.7℃≤體溫35.9℃)的現(xiàn)象。 2.體溫方面：與t1比較,t2、t3、t4體溫明顯下降；與t3及t4相比,t5的體溫有明顯上升。(P0.05) 3.腦氧代謝相關(guān)指標(biāo)頸靜脈球部血氧飽和度：在t3、t4時較t1時明顯升高,在t5時又較t4時明顯下降。頸內(nèi)動靜脈氧含量差方面：與t1相比,t2、t3、t4、t5均減少有統(tǒng)計學(xué)差異；與t2相比,t4的減少程度也有統(tǒng)計學(xué)差異；與t4相比,t5開始回升有統(tǒng)計學(xué)差異。腦氧攝取率方面：與t1及t2相比,t4明顯下降；而t3與t1相比也有統(tǒng)計學(xué)差異；與t4相比,t5開始上升并有統(tǒng)計學(xué)意義。(P0.05) 4.體溫與頸靜脈球部血氧飽和度相關(guān)性顯示：r=-0.300,p=0.002。體溫與頸內(nèi)動靜脈氧含量差相關(guān)性顯示：r=0.341,p=0.001；體溫與腦氧攝取率相關(guān)性分析顯示r=0.317,p=0.001,表明體溫與腦氧代謝呈線性相關(guān)。(P0.01) 結(jié)論： 在我院層流手術(shù)室條件下開展的神經(jīng)外科擇期開顱手術(shù)中,無需對患者采用特別的降溫措施,患者的體溫可出現(xiàn)一定程度的下降,下降幅度安全,無不良反應(yīng),其腦氧代謝也可因手術(shù)過程及麻醉所致的低溫及其它如麻醉藥物等的影響而出現(xiàn)一定的下降,從而使腦組織得到一定的保護。
[Abstract]:Objective: to observe the changes of body temperature and cerebral oxygen metabolism in patients undergoing elective neurosurgery in our hospital, and to explore the correlation between them, and to provide evidence for brain protection by hypothermia during neurosurgery. Methods: twenty patients with selective intracranial space occupying operation were collected, and routine thermal insulation was performed after entering the operating room to monitor BPH-HRG and SPO _ 2. After endotracheal intubation induced by anesthesia, arterial barometric tubes were placed through radial artery, and dual vena cava catheter was retrograde placed through right internal jugular vein to ensure that the front end was located between the second cervical vertebra and the skull. The nasopharyngeal temperature probe was inserted into the pharyngeal cavity through the nasal cavity. Immediately after tracheal intubation (T1), dura mater incision (T2), tumor 1 hour (T3), dura suture (t4), extubation 10 minutes (t5), body temperature was recorded and blood gas analysis of radial artery and internal jugular vein blood were performed simultaneously. Oxygen saturation, hemoglobin content and so on. Internal carotid artery, internal jugular vein blood oxygen content and difference, cerebral oxygen uptake rate were calculated according to FICK formula. Results: 1.Twenty patients had increased blood oxygen saturation in jugular bulbar, poor blood oxygen content in carotid artery and vein and decreased cerebral oxygen uptake rate. 2. Among them, 18 cases had hypothermia (34.7 鈩，

本文編號：2172694