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| 长时间CO2气腹和Trendelenburg体位对中老年患者直肠癌根治术中脑氧饱和度的影响 |
| Effect of long-term CO2 pneumoperitoneum in Trendelenburg position on cerebral oxygenation of middle-aged and elderly patients undergoing radical resection of rectal cancer |
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| DOI：10.12089/jca.2020.02.011 |
| 中文关键词: CO2气腹 Trendelenburg体位 脑氧饱和度 |
| 英文关键词: CO2 pneumoperitoneum Trendelenburg position Cerebral oxygenation |
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| 中文摘要: |
目的 评估腹腔镜下直肠癌根治术中长时间CO2气腹和Trendelenburg体位对中老年患者脑氧饱和度(rSO2)的影响。
方法 选择拟行腹腔镜下直肠癌根治术患者38例,男19例,女19例,年龄45～80岁,BMI 18～25 kg／m2,ASA Ⅰ 或 Ⅱ 级。根据年龄分为两组:45～64岁为中年组(M组),65～80岁为老年组(O组)。两组均常规全麻插管,记录诱导结束后10 min(T0)、Trendelenburg体位后30 min(T1)、1 h(T2)和2 h(T3)的HR、MAP、PETCO2、PaCO2、PaO2、rSO2等。采用Pearson检验分析rSO2与年龄的相关性。记录术后3 d内急性脑卒中和术后谵妄(POD)等神经系统相关不良反应的发生情况。
结果 与T0时比较,T1—T3时两组rSO2均明显升高(P＜0.05)。T0时M组rSO2明显高于O组(P＜0.05)。不同时点两组HR、MAP、PETCO2、PaCO2、PaO2差异无统计学意义。T0时rSO2与年龄呈明显负相关(r=-0.650,P＜0.05)。T1、T2时rSO2与年龄未见明显相关性。T3时rSO2和年龄之间呈明显正相关(r=0.488,P＜0.05)。两组术后无一例急性脑卒中和POD等神经系统相关不良反应发生。
结论 在需要Trendelenburg体位的腹腔镜手术中,尤其对于老年患者,应该加强rSO2监测,避免脑氧供氧需失衡带来的神经系统并发症。 |
| 英文摘要: |
Ojective To evaluate the effect of long-term CO2 pneumoperitoneum and Trendelenburg position on cerebral oxygenation (rSO2) in middle-aged and elderly patients during laparoscopic radical resection of rectal cancer.
Methods Thirty-eight patients undergoing laparoscopic radical resection of rectal cancer, 19 males and 19 females, aged 45-80 years, with a BMI 18-25 kg／m2, falling into ASA physical status Ⅰ or Ⅱ, were enrolled in this study. All gatients were divided into two groups according to age: 45-64 years old for middle-aged group (group M) and 65-80 years old for elderly group (group O). General anesthesia intubation was conducted in both groups, and the HR, MAP, PETCO2, PaCO2, PaO2 and rSO2 were recorded 10 min (T0) after induction, 30 min (T1), 1 h (T2), and 2 h (T3) after Trendelenburg position. Pearson correlation test was used to analyze the correlation between rSO2 and age. Nervous system-related adverse events such as acute stroke and postoperative delirium (POD) were recorded on the 3rd day after surgery.
Results Compared with T0, rSO2 was higher at T1-T3 in the two groups (P ＜ 0.05). The rSO2 in group M was higher than that in group O at T0(P ＜ 0.05). There were no statistical differences in HR, MAP, PETCO2, PaCO2 and PaO2 between the two groups at each time point. There was no significant correlation between rSO2 and age at T1 and T2. There was a negative correlation between rSO2 and age at T0 (r = -0.650, P ＜ 0.05), and positive at T3(r = 0.488, P ＜ 0.05). There were no cases of neurological related adverse reactions such as acute stroke and POD in the two groups after surgery.
Conclusion During the operation with CO2 pneumoperitoneum and Trendelenburg position, we should pay more attention to monitoring rSO2 to avoid neurological complications, especially for elderly people. |
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