文章摘要
控制性降压时不同通气策略对沙滩椅体位手术患者脑氧饱和度的影响
Effects of different ventilation strategies on cerebral oxygen saturation in patients undergoing beach chair posture surgery under induced hypotension
  
DOI：10.12089/jca.2018.06.011
中文关键词: 沙滩椅体位  脑血氧饱和度  通气策略  平均动脉压  近红外光谱仪
英文关键词: Beach chair position  Cerebral regional oxygen saturation  Ventilation strategy  Mean arterial pressure  Near infrared spectrometer
基金项目:
作者单位E-mail
闫婷婷 230001,合肥市,安徽医科大学附属省立医院麻醉科  
柴小青 230001,合肥市,安徽医科大学附属省立医院麻醉科 xiaoqingchai@163.com 
魏昕 230001,合肥市,安徽医科大学附属省立医院麻醉科  
王迪 230001,合肥市,安徽医科大学附属省立医院麻醉科  
马骏 230001,合肥市,安徽医科大学附属省立医院麻醉科  
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中文摘要:
      
目的 观察四种不同通气策略在控制性降压下对沙滩椅体位手术患者脑氧饱和度(cerebral regional oxygen saturation,rSO2)的影响。

方法 全麻下择期行肩关节手术患者58例,男17例,女41例,年龄45～64岁,ASA Ⅰ或Ⅱ级,采用随机数字表法分为四组:A组:FiO2 0.4和PETCO2 30～35 mmHg;B组:FiO2 1.0和PETCO2 30～35 mmHg;C组:FiO2 0.4和PETCO2 40～45 mmHg;D组:FiO2 1.0和PETCO2 40～45 mmHg。采用近红外光谱仪(near infrared spectrometer, NIRS)监测患者rSO2。当患者取沙滩椅体位后,调整RR使PETCO2维持所需水平,采用血管活性药物控制性降压（MAP 60～70 mmHg）,记录麻醉诱导后(T1)、改为沙滩椅体位后5 min(T2)、通气策略调控后5 min(T3)、30 min(T4)、60 min(T5)及改平卧位后5 min(T6)时的MAP和rSO2。

结果 与T1时比较,T2时四组MAP和rSO2明显降低(P<0.05);与T5时比较,T6时四组MAP及rSO2明显升高(P<0.05)。T3—T5时,B组、C组rSO2明显高于A组,D组rSO2明显高于B、C组(P<0.05)，B、C组rSO2差异无统计学意义。

结论 沙滩椅位患者术中采用低吸入氧浓度并维持较高的呼气末二氧化碳在血压调控下可维持患者有效脑氧供需良好的脑灌注,适用于肩关节镜手术。
英文摘要:
      
Objective To investigate the effects of different ventilation strategies on brain oxygen saturation in patients with beach chair position under induced hypotension.

Methods Fifty-eight patients in beach chair posture surgery under general anesthesia, 17 males and 41 females, aged 45-64 years, ASA physical status Ⅰ or Ⅱ, were randomly divided into four groups, group A: fraction of inspired oxygen (FiO2) 0.4 and PETCO2 30-35 mmHg; group B: FiO2 1.0 and PETCO2 30-35 mmHg; group C: FiO2 0.4 and PETCO2 40-45 mmHg; group D: FiO2 1.0 and PETCO2 40-45 mmHg. The rSO2 was monitored using the near infrared spectrometer (NIRS). When the patients take the beach chair position, the PETCO2 can be maintained by adjusting the breathing frequency. The mean arterial pressure was maintained at 60-70mmHg by using vasoactive drugs in all groups. MAP and rSO2 were recorded after induction of anesthesia (T1), 5 min after the beach chair position (T2), 5 min after ventilation control strategy (T3), 30 min after ventilation control strategy (T4), 60 min after ventilation control strategy (T5) and 5 min after supine (T6).

Results Compared with T1, MAP and rSO2 in all four groups were significantly decreased at T2 (P < 0.05). Compared with T5, MAP and rSO2 in all four groups were significantly increased at T6 (P < 0.05). Compared with group A, the rSO2 of groups B and C were significantly increased at T3-T5. Compared with group B, the rSO2 of groups D were significantly increased at T3-T5. Compared with group B and group C, the rSO2 of groups D were significantly increased at T3-T5 (P < 0.05). There was no statistically significant difference in rSO2 between group B and group C.

Conclusion Lower oxygen inhalation and higher end tidal carbon dioxide combined with induced hypotension can maintain cerebral perfusion well in patients with beach chair position for shoulder arthroscopic surgery.
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