【摘要】：目的研究胸科手術(shù)單肺通氣(OLV)期間與局部腦氧飽和度(rScO_2)下降的相關(guān)因素。方法序貫納入2016年5至10月在北京協(xié)和醫(yī)院實(shí)施全麻單肺通氣的胸科手術(shù)患者33例,ASAⅠ~Ⅲ級。采用靜脈誘導(dǎo),術(shù)中吸入七氟醚維持。OLV期間,維持潮氣量為6~7 ml/kg,呼氣末二氧化碳分壓(PetCO_2)在35~45 mmHg(1 mmHg=0.133 kPa)。麻醉過程中,維持脈搏血氧飽和度90%,收縮壓90 mmHg或降低不超過基礎(chǔ)值的30%,心率50次/min,血紅蛋白90 g/L。采用FORESIGHT電極探頭持續(xù)監(jiān)測rScO_2,根據(jù)術(shù)中rScO_2的最低值是否低于65%或較基礎(chǔ)值降低15%以上將患者分為低rScO_2組(L-rScO_2組)(n=10)和高rScO_2組(H-rScO_2組)(n=23)。比較兩組患者的性別、年齡、體質(zhì)量指數(shù)、術(shù)中血紅蛋白及rScO_2最低時(shí)點(diǎn)的氣道峰壓(Ppeak)、收縮壓、PetCO_2和SpO_2。結(jié)果 L-rScO_2組的Ppeak顯著高于H-rScO_2組(P=0.028),而收縮壓顯著低于H-rScO_2組(P=0.046),L-rScO_2組的SpO_2有低于H-rScO_2組的趨勢,但差異無統(tǒng)計(jì)學(xué)意義(P=0.421)。非條件Logistic回歸分析示Ppeak是導(dǎo)致OLV期間rScO_2降低的相關(guān)因素。結(jié)論胸科手術(shù)OLV期間,Ppeak與術(shù)中rScO_2的下降存在關(guān)聯(lián)。
[Abstract]:Objective to study the factors related to the decrease of regional cerebral oxygen saturation (rsco _ 2) during single lung ventilation (OLV) in thoracic surgery. Methods from May to October 2016, 33 patients undergoing single lung ventilation under general anesthesia in Beijing Union Hospital were enrolled in this study. After intravenous induction, the tidal volume was 6 ~ 7 ml / kg, and the end-expiratory carbon dioxide partial pressure (PetCO2) was 35 ~ 45 mmHg (1 mm HgG 0.133 KPA) during the maintenance of OLV by inhalation of sevoflurane. During anesthesia, maintain pulse oxygen saturation 90, systolic blood pressure 90 mmHg or decrease the baseline value by 30, heart rate 50 beats / min, hemoglobin 90 g / L. Using FORESIGHT electrode probe to continuously monitor rScO2s, patients were divided into low rScO2 group (L-rScO2 group) and high rScOStates2 group (H-rScOSn2 group) according to whether the minimum value of rScO2 during operation was lower than 65% or more than 15% lower than the basic value. The patients were divided into low rScO2 group (L-rScO2 group) and high rScOSn2 group (H-rScOSn2 group) (nc23). Gender, age, body mass index, intraoperative hemoglobin and peak airway pressure (Ppeak) at the lowest time point of rScO2, systolic blood pressure, PetCO2 and Spo _ 2 were compared between the two groups. Results the Ppeak of group L-rScO2 was significantly higher than that of group H-rScO _ 2 (P _ (0.028), but the systolic pressure was significantly lower than that of group H-rScO _ (2) (P _ (0.046). The SPO _ (2) of group L ~ (rScO) _ 2 was lower than that of group H-rScO _ (2), but there was no significant difference (P _ (0.421). Non-conditional logistic regression analysis showed that Ppeak was the related factor that led to the decrease of rScOII during OLV. Conclusion there is a correlation between Ppeak during OLV and the decrease of rsco _ 2 during operation.
【作者單位】： 中國醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院北京協(xié)和醫(yī)院麻醉科;北京市房山區(qū)第一醫(yī)院麻醉科;
【分類號】：R614

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