摘要
目的观察反屈氏位腹腔镜手术期间，患者无创局部脑氧饱和度（cerebraltissueoxygensaturation，ScrO2）变化及特点。方法选择择期行腹腔镜手术的胃肠道肿瘤患者20例，采用无创FORE—SIGHT近红外光仪监测双侧额部ScrO2，清醒状态下记录基础值（T0），分析二氧化碳（CO2）气腹前（T1）以及30°反屈氏位气腹下每隔15min（T2～T9）呼气末二氧化碳分压（end-tidalcarbondioxide，PETCO2）及ScrO2数据，同期采集患者的平均动脉压（meanarterialpressure，MAP）和体温，以及术前、术后的血红蛋白浓度。计算气腹期间ScrO2的变化幅度。随访术后神经系统并发症。结果①患者麻醉前清醒状态下ScrO2基础值：左侧为（72±6）％、右侧为（72±4）％，气腹前：左侧（75±6）％、右侧（74±5）％。气腹75min后ScrO2增高达峰值：左侧为（84±5）％、右侧为（81±4）％，均较基础值显著增加（P〈0．05）。②气腹期间，与气腹前比较ScrO2左侧增幅（8±6）％，右侧增幅（8±6）％，增幅最大值左侧达15．49％，右侧达17．14％。③CO2气腹期间PETCO2的变化：气腹前为（33．8±2．3）mmHg（1mmHg=0．133kPa），气腹15min后达到（38．4±2．8）mmHg，75min后达峰值（40.8±2．2）mmHg，均较气腹前显著增加（P〈0．05）。④各时点MAP、体温、血红蛋白浓度间差异无统计学意义。结论反屈氏位CO2气腹条件下ScrO2持续增高，与CO2气腹所致的高碳酸血症性脑血管扩张及脑血流增加、吸入氧浓度升高有关，适度高碳酸血症有益于CO2气腹下脑氧供需平衡的维持。
Objective To observe the variation characteristics of cerebral tissue oxygen saturation in the reverse （30° ） Trendelenburg position during laparoscopic surgery. Methods Patients with gastric cancer undergoing laparoscopic surgery were monitored intraoperatively using the FORE-SIGHT cerebral oximeter. Two sensors were placed on the subject＇s forehead bilaterally for continuous monitoring of cerebral tissue oxygen saturation （ScrO2）. The subjects were in the reverse Trendelenburg position during surgery. ScrO2, end-tidal carbon dioxide（PETCO2）, mean arterial pressure（MAP） and Temperature were recorded every fifteen minutes after carbon dioxide pneumoperitoneum. Meanwhile, concentration of hemoglobin are examinated at preoperation and postoperation. All patients were followed up for neurological complications. Results 20 patients were monitored. The patients＇ age ranged from 34 to 80 years. The base value of Scr02 was （72±6）% on the left sensor, and （72± 4）% on the fight sensor. The ScrO2 maximum values were（84±5）% on the left sensor, and（81±4）% on the right sensor after 75 min carbon dioxide pneumoperitoneum. During pneumoperitoneum the ScrO2 values increased by （8±6）% on the left sensor, and （8±6）% on the right sensor. The maximum increasing amplitudes of ScrO2 were 15.49% （left） and 17.14% （right） respectively during CO2 pneumoperitoneum. The PgrCO2 values before pneumoperitoneum, 15 rain and 75 min pneumoperitoneum were（33.8±2.3 ） mmHg, （38.4±2.8） mmHg and（40.8±2.2） mmHg, respectively. There were no significant difference in MAP, Temperature and hemoglobin concentration. Neurological complications of postoperation were not found. Conclusions The ScrO2 values increased under reverse trendelenburg and carbon dioxide pneumoperitoneum because of the raised FiO2 and cerebral blood flow due to hypercapnia which can contributed to maintain cerebral oxygen supply and demand balance.
出处
《国际麻醉学与复苏杂志》
CAS
2014年第3期229-232,共4页
International Journal of Anesthesiology and Resuscitation
关键词
脑氧饱和度
二氧化碳气腹
腹腔镜手术
Cerebral tissue oxygen saturation
Carbon dioxide pneumoperitoneum
Laparoscopic surgery
