允许性高碳酸血症联合星状神经节阻滞对肩关节镜手术中脑氧合的影响

袁晨; 韩丽; 倪亚平; 吴一帆; 佘远时; 沈军; 杨芬; 谢阳

文章摘要

允许性高碳酸血症联合星状神经节阻滞对肩关节镜手术中脑氧合的影响

Effect of permissive hypercapnia combined with stellate ganglion block on intraoperative cerebral oxygenation in arthroscopic shoulder surgery

DOI：10.12089/jca.2025.07.009

中文关键词: 星状神经节阻滞允许性高碳酸血症局部脑氧饱和度肩关节镜手术沙滩椅位脑保护

英文关键词: Stellate ganglion block Permissive hypercapnia Regional cerebral oxygen saturation Shoulder arthroscopy Beach chair position Cerebral protection

基金项目:上海闵行区卫生健康委员会科研课题（2023MW69）

作者	单位	E-mail
袁晨	215002,南京医科大学附属苏州医院,苏州市立医院麻醉科
韩丽	215002,南京医科大学附属苏州医院,苏州市立医院麻醉科
倪亚平	215002,南京医科大学附属苏州医院,苏州市立医院麻醉科
吴一帆	215002,南京医科大学附属苏州医院,苏州市立医院麻醉科
佘远时	215002,南京医科大学附属苏州医院,苏州市立医院骨外科
沈军	215002,南京医科大学附属苏州医院,苏州市立医院骨外科
杨芬	215002,南京医科大学附属苏州医院,苏州市立医院麻醉科
谢阳	215002,南京医科大学附属苏州医院,苏州市立医院麻醉科	xieyangeagle@163.com

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中文摘要:

目的：通过监测沙滩椅位（BCP）肩关节镜手术患者的局部脑氧饱和度（rScO₂）变化，探究允许性高碳酸血症（PHC）联合星状神经节阻滞（SGB）对患者术中脑氧合的影响。
方法：选择择期行肩关节镜手术患者120例，男58例，女62例，年龄18～64岁，BMI 18.5～27.0 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为三组：对照组（C组）、PHC组（P组）和SGB联合PHC组（SP组）。麻醉诱导前，SP组在超声引导下行术侧SGB，颈长肌表面的星状神经节处注射0.25%罗哌卡因+1%利多卡因混合液5 ml，C组和P组于同一部位注射等容量生理盐水。10 min后麻醉诱导行气管插管机械通气辅助呼吸，改为BCP开始手术。术中调整VT及RR，P组和SP组控制P_ETCO₂升至50 mmHg，C组控制P_ETCO₂ 40 mmHg。记录入室时（T0）、SGB操作后10 min（T1）、BCP 5 min（T2）、手术开始后30 min（T3）、手术开始后1 h（T4）、手术结束时（T5）术侧和非术侧rScO₂、HR、MAP、SpO₂、PaCO₂、P_ETCO₂。记录术前1 d、术后1、2 d静息时VAS疼痛评分。记录术中大脑去氧饱和度事件（CDE）的发生情况、术中血管活性药物使用情况和术后恶心、呕吐、头晕等不良反应的发生情况。
结果：与T2时比较，P组T4、T5时术侧和非术侧rScO₂明显升高，SP组T3—T5时术侧rScO₂和T4、T5时非术侧rScO₂明显升高（P＜0.05）。与C组比较，P组T5时术侧rScO₂明显升高，SP组T3—T5时术侧rScO₂和T5时非术侧rScO₂明显升高（P＜0.05）。与P组比较，T3—T5时SP组术侧rScO₂明显升高（P＜0.05）。与T0时比较，T3—T5时P组和SP组PaCO₂、P_ETCO₂明显升高（P＜0.05）。与C组比较，T3—T5时P组和SP组PaCO₂、P_ETCO₂明显升高（P＜0.05）。三组不同时点HR、MAP、SpO₂、静息时VAS疼痛评分、术中CDE发生率、术中血管活性药使用率及术后不良反应发生率差异无统计学意义。
结论：PHC可改善肩关节镜手术患者双侧rScO₂，PHC联合SGB较单独使用PHC能进一步改善患者术侧脑氧合，提高rScO₂，降低脑血管事件的风险。

英文摘要:

Objective: To investigate the effect of permissive hypercapnia (PHC) combined with stellate ganglion block (SGB) on the intraoperative cerebral oxygenation in patients undergoing shoulder arthroscopy in the beach chair position (BCP), by monitoring changes in regional cerebral oxygen saturation (rScO₂).
Methods: A total of 120 patients scheduled for elective shoulder arthroscopy were enrolled, 58 males and 62 females, aged 18-64 years, BMI 18.5-27.0 kg/m², ASA physical status Ⅰ or Ⅱ. The patients were randomly assigned into three groups using a random number table: control group (group C), PHC group (group P), and SGB combined with PHC group (group SP). A stellate ganglion block was performed under ultrasound guidance at the level of the cervical longus colli muscle with a mixture of 0.25% ropivacaine and 1% lidocaine 5 ml injected 10 minutes before general anesthesia induction in group SP. The patients in groups C and P received an equal volume of normal saline injection. Anesthesia induction was performed 10 minutes later, and tracheal intubation with mechanical ventilation was initiated, followed by positioning the patient in the BCP for surgery. Ventilator parameters (VT and RR) were adjusted, and P_ETCO₂ was maintained at 50 mmHg in groups P and SP, while it was maintained around 40 mmHg in group C. The rScO₂ on both surgical and non-surgical sides, HR, MAP, SpO₂, P_ETCO₂, and PaCO₂ were recorded at the following time points: preoperative (T0), 10 minutes after SGB (T1), 5 minutes after BCP positioning (T2), 30 minutes after the surgery commencement (T3), 1 hour after the surgery commencement (T4), and at the end of the surgery (T5). The VAS pain scores at rest were recorded 1 day before the surgery, 1 day and 2 days after the surgery. The incidents of cerebral desaturation events (CDE) and use of vasoactive drugs during the operation, and the incidence of postoperative nausea, vomiting, and dizziness were also recorded.
Results: Compared with T2, the rScO₂ on the surgical and non-surgical sides in group P was significantly increased at T4 and T5, and the rScO₂ on the surgical side at T3-T5 and the rScO₂ on the non-surgical side at T4 and T5 in group SP were significantly increased (P < 0.05). Compared with group C, the rScO₂ on the surgical side in group P was significantly increased at T5, and the rScO₂ on the surgical side at T3-T5 and the non-surgical side at T5 in group SP were significantly increased (P < 0.05). Compared with group P, the rScO₂ on the surgical side in group SP was significantly increased at T3-T5 (P < 0.05). Compared with T0, PaCO₂ and P_ETCO₂ in groups P and SP were significantly increased at T3-T5 (P < 0.05). Compared with group C, PaCO₂ and P_ETCO₂ in groups P and SP were significantly increased at T3-T5 (P < 0.05). There was no statistically significant difference in HR, MAP, SpO₂, and VAS pain scores at rest at different time points, incidence of intraoperative CDE, utilization rate of intraoperative vasoactive drugs and incidence of postoperative adverse reactions among the three groups.
Conclusion: PHC can improve bilateral rScO₂ in patients undergoing arthroscopic shoulder surgery, and PHC combined with SGB can further improve the intraoperative cerebral oxygenation of patients, increase rScO₂, and reduce the risk of cerebrovascular events compared with PHC alone.

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