局部脑氧饱和度监测在老年患者术中应用的研究进展

背景 局部脑氧饱和度(regional cerebral oxygen saturation,rSO2)监测是一种新型无创监测脑氧平衡的方法,老年患者术中实时监测rSO2可以优化老年患者围手术期的管理,降低术后神经系统并发症的发生. 目的 为rSO2监测的相关研究和临床应用提供参考. 内容 主要介绍rSO2的基本原理、影响因素及rSO2在老年患者心脏手术、神经外科手术、胸外科、腹外科及骨科中的应用. 趋向 积极探索rSO2在老年患者中的应用价值,减少老年患者术后并发症.     

儿童腹腔镜手术对局部脑氧饱和度的影响

目的评估儿童腹腔镜手术对局部脑氧饱和度是否有影响。方法选择年龄在5～10岁急性阑尾炎患儿40例,ASAⅠ～Ⅱ级。将患儿依据手术方式分为两组,腹腔镜组(L组)和开腹组(O组),每组各20例。两组患儿均采用气管内插管全身麻醉,舒芬太尼、丙泊酚和罗库溴铵快速诱导插管,术中泵注瑞芬太尼、丙泊酚维持麻醉,机械通气采用80%氧浓度。分别记录手术及麻醉时间,呼气末二氧化碳压力(P_(ET)CO_2),记录麻醉诱导后和开始手术前(T_0,基线),手术开始后15分钟(T_1),30分钟(T_2),45分钟(T_3),60分钟(T_4)和手术结束(T_5)的血流动力学参数,如心率(HR),平均动脉压(MAP),血氧饱和度(SpO_2)及左右局部脑氧饱和度(LrScO_2,RrScO_2)。结果L组患儿在手术开始后T_1、T_2、T_3时间段PETCO_2高于O组,与T_0比较,两组患儿在T_1时的LrScO_2(L组:77. 2±5. 5,O组:79. 2±5. 5)和RrScO_2(L组:80. 1±5. 1,O组:81. 6±3. 2),均逐渐下降,但均正常范围内,两组比较差异无统计学意义(P 0. 05)。结论儿童腹腔镜手术对局部脑氧饱和度无明显影响。     

腹腔镜手术对脑氧饱和度的影响

腹腔镜手术对脑氧饱和度的影响沈茂华１徐美英２于布为２腹腔镜手术是近年来开展的新手术。由于需要用ＣＯ２施行气腹以暴露腹内脏器，因而带来一系列的生理改变。已知ＣＯ２气腹可引起一定程度的血流动力学和呼吸力学的扰乱，且随气腹时间延长、通气效能下降、ＣＯ２经腹...     

脑氧饱和度监测下控制性降压对老年高血压患者术后谵妄的影响

目的 探讨脑氧饱和度(rSO₂)监测下控制性降压对老年高血压患者术后谵妄（POD）的影响。方法 择期全麻下行鼻泪道手术的老年高血压患者110例,男53例,女57例,年龄65~85岁,ASA Ⅱ或Ⅲ级,高血压Ⅰ或Ⅱ级,采用随机数字表法分为两组：rSO₂监测组（S组）和对照组（C组）,每组55例。两组均采用乌拉地尔联合艾司洛尔控制性降压,维持MAP≥基础值的70%,且MAP≥55 mmHg;当S组rSO₂<基础值的80%或rSO₂最低值<基础值的50%,并且持续时间大于10 s,则逐步提升血压直至rSO₂恢复至≥基础值的80%或绝对值＞50%。C组rSO₂监护仪施行遮盖处理。记录入室后吸氧5 min（T0）、控制性降压15 min（T1）、30 min（T2）、控制性降压结束后5 min（T3）、拔管后10 min（T4）的HR、MAP、rSO₂;记录rSO₂基础值、术中最低值及较基础值下降的最大百分比;术后1、2、3 d采用谵妄评定方法 中文修订版（CAM-CR量表）对患者进行POD评估。结果 与T0时比较,T1—T2时两组MAP明显下降（P<0.05）,C组rSO₂明显下降（P<0.05）,T3—T4时逐渐回升至术前水平。T1—T2时S组rSO₂明显高于C组（P<0.05）,术中rSO₂最低值明显高于C组（P<0.05）,rSO₂较基础值下降的最大百分比明显低于C组（P<0.05）。术后1 d S组POD发生率明显低于C组（P<0.05）。结论 rSO₂监测下控制性降压能减少老年高血压患者鼻泪道手术后谵妄的发生,提高围术期安全性。     

尼卡地平控制性降压对局部脑氧饱和度的影响

目的观察颅内动脉瘤夹闭术中控制性降压对局部脑氧饱和度(rScO2)的影响。方法 15例ASAⅠ级的择期颅内动脉瘤夹闭手术患者,丙泊酚-瑞芬太尼全凭静脉麻醉,暴露动脉瘤期间静脉泵注尼卡地平0.5～1μg·kg-1·min-1,逐渐降低术前基础MAP的10%、20%和30%,夹闭动脉瘤后停止降压,观察降压过程中MAP、HR和rScO2的变化趋势。结果尼卡地平控制性降压过程中,随着MAP的逐渐下降,rScO2略有升高,T5时rScO2恢复至T1水平,各时点MAP、HR、PETCO2、BIS和rScO2差异均无统计学意义。结论颅内动脉瘤夹闭术中应用尼卡地平行控制性降压安全可行,不会影响脑氧供需平衡。     

围术期持续泵注甲氧明对老年胃肠手术患者局部脑氧饱和度及预后的影响

老年患者由于脑血管的自我调节能力下降,术中血流动力学波动时易发生脑血流灌注不足,从而导致脑功能受损.甲氧明是一种高选择性α1 受体激动药,通过升高血压从而增加脑灌注压.有研究[1]表明,不同血管升压药对局部脑氧饱和度( regional cerebral oxygen saturation, rScO2 )影响不同,甚...     

患儿主动脉弓部手术中局部脑氧饱和度和躯体氧饱和度的变化

目的观察和比较局部脑氧饱和度(SctO_2)和躯体氧饱和度(SstO_2)在患儿主动脉弓部手术中的变化。方法收集2015年1月至2017年2月收治的主动脉弓缩窄(coarctation of aorta,COA)或主动脉弓离断(interruption of aortic arch,IAA)合并心内畸形,择期在心肺转流(cardiopulmonary bypass,CPB)联合选择性脑灌注(selective cerebral perfusion,SCP)下行一期矫治术的患儿21例,男16例,女5例,年龄12 d至11个月,体重3～6 kg ASAⅢ或Ⅳ级。采用全身麻醉和常规监测,同时持续监测右额部和背部局部组织氧饱和度,分别为SctO_2和SstO_2。于诱导时(T_0)、切皮时(T_1)、CPB开始(T_2)、SCP开始(T_3)、停SCP(T_4)、主动脉开放(T_5)、停CPB(T_6)、术毕(T_7)时记录SctO_2、SstO_2、中心静脉氧饱和度(ScvO_2)。结果与T_0时比较,T_2、T_5、T_6时SctO_2明显降低(P0.05)。T_0—T_4时SctO_2明显高于SstO_2(P0.05);T_5—T_7时SctO_2明显低于SstO_2(P0.05)。SctO_2与ScvO_2的Pearson相关系数r=0.80(P0.05)。结论在患儿主动脉弓部手术中,SctO_2和SstO_2差异和变化较大,可以依据其变化趋势,指导术中精细化调控。     

Study of Regional Cerebral Oxygen Saturation During Percutaneous Cardiopulmonary Support

Abstract: The purpose of this study was to evaluate the change of regional cerebral oxygen saturation (rSo₂) during percutaneous cardiopulmonary support (PCPS) in patients with cardiogenic shock. Fifteen patients with cardiogenic shock were evaluated during PCPS by continuous monitoring of rSo₂, systemic venous oxygen saturation (Svo₂), and hemodynamics. The brain damage of these patients was also evaluated during and after PCPS. There were 10 males and 5 females. Their ages ranged from 57 to 79 years old (average: 60.0 ± 14). Two patients were unconscious before PCPS, and 11 received intraaortic balloon pumping (IABP) before PCPS. The change of rSo₂was significantly correlated with the change of Svo,. The average of rSo₂was 64 ± 3% at the stable hernodynamic condition. The rSo₂with pulsatile PCPS was higher than that with nonpulsatile PCPS. There was no correlation between brain damage and rSo₂. The patients with low rSo₂(40%) that resulted in poor LV function could not be weaned from PCPS. In conclusion, the continuous monitoring of rSo₂during PCPS could be a useful tool.     

Aortic Arch Surgery With a Single Centrifugal Pump for Selective Cerebral Perfusion and Systemic Circulation

In aortic arch surgery, two pumps are required for systemic perfusion and selective cerebral perfusion (SCP). A new technique with a single centrifugal pump for systemic perfusion and SCP was developed and its efficacy and safety evaluated. This technique was adopted for total arch replacement in 22 consecutive patients with true aneurysms (13) and aortic dissection (nine) from January 2005 to January 2008. Cerebral perfusion lines branched from the main perfusion line. During SCP, right radial arterial pressure was maintained at 50 mm Hg and left common carotid arterial pressure at 60 mm Hg, and the regional cerebral oxygen saturation (rSO₂) values were maintained at approximately >80% of the baseline value. Two operative deaths (9%) occurred due to pneumonia and hemorrhage in the left lung, respectively. Stroke occurred in one patient (5%). This simple circuit system can thus be easily and safely applied for aortic arch surgery.     

麻醉期手术中高血压病人血浆心钠素水平的变化

目的和方法：本文测定了１４例高血压患者和１０例血压正常者在麻醉前，后，手术探查时，窥喉插管时及术毕血浆心钠素（ＡＮＰ）的变化。结果：窥喉插管时，高血压患者ＡＮＰ明显升高。术毕停用麻醉药３０ｍｉｎ，两组ＡＮＰ均明显升高。     

心脏手术后混合静脉血氧饱和度与血容量心指数相关分析

为阐明混合静脉血氧饱和度（ＳｖＯ２）是否能有效监测术后血容量（ＢＶ）及心输出量（ＣＯ）变化。作者对２４例心脏术后病例分别于术毕处于机械通气及睡眠状态（术后Ｉ组），术后６小时处于机械通气及清醒状态（术后Ｉ组），及术后２４小时处于自主呼吸及清醒状态（术后ＩＩ组）下测定ＳｖＯ２与ＢＶ、心指数（ＣＩ）进行相关分析。结果：术后Ｉ组ＳｖＯ２与ＢＶ、ＣＩ相关系数分别为０．７８５６和０．８０４０（Ｐ＜０．００１）；术后ＩＩ组为０７７８１和０８８１５（Ｐ＜０００１）；术后ＩＩ组为０．７２４３和０．８５３３（Ｐ＜０．００１）。结论：心脏术后不同条件下ＳｖＯ２与ＢＶ、ＣＩ具显著相关性，ＳｖＯ２作为术后ＢＶ及ＣＯ变化的一种监测指标是敏感可靠的。     

全麻联合硬膜外阻滞及术后镇痛对上腹部手术围术期生长激素、胰岛素和血糖的影响

目的：观察全麻联合硬膜外阻滞并保留术后镇痛对围术期上腹部手术应激反应和糖代谢的影响。方法：择期胆囊切除病人３０例,随机分为三组,每组１０例,Ⅰ组全麻联合硬膜外阻滞并保留术后镇痛,Ⅱ组硬膜外阻滞保留术后镇痛,Ⅲ组硬膜外阻滞不保留术后镇痛,观察围术期血浆生长激素（ＣＨ）、血糖（ＢＳ）和胰岛素（Ｉｎｓ）浓度变化,结果：与麻醉前比,Ⅰ组术中和术后ＧＨ、ＢＳ平稳,⒓、醇组术中和术毕即刻ＢＳ明显升高,但术后２     

Accuracy of Regional Cerebral Oxygen Saturation in Predicting Postoperative Cognitive Dysfunction After Total Hip Arthroplasty : Regional Cerebral Oxygen Saturation Predicts POCD

To estimate the accuracy of regional cerebral oxygen saturation (rSO₂) in predicting postoperative cognitive dysfunction (POCD) for patients undergoing total hip arthroplasty, 46 patients aged more than 50 years old were enrolled. We measured the patients’ cognitive function by using a battery of six neuropsychological tests before surgery and then 7 days after surgery again. rSO₂ was continuously monitored by near-infrared spectroscopy during surgery. POCD was present in 9 (19.6%) patients 1 week after surgery. Logistic regression analysis showed that increasing age [OR = 1.224, P = 0.035] and maximum percentage drop in rSO₂ (rSO_2%max) [OR = 1.618, P = 0.011] were significant risk factors for POCD. The area under the receiver operating characteristic curve of rSO_2%max was 0.833 [95% confidence interval (CI) 0.615–1.051] at cutoff value of 11%. The specificity and sensitivity of rSO_2%max > 11% in predicting POCD were 77.8% and 86.5%, respectively. rSO_2%max more than 11% was a potential predictor for POCD.     

The Effect of Statins on Perioperative Events in Patients Undergoing Vascular Surgery

Despite recent advancements in perioperative care and guideline recommendations, patients undergoing vascular surgery remain at risk for perioperative cardiovascular complications. In this review, the results are summarized of the most recent studies on the effectiveness and safety of perioperative statin use for the prevention of these perioperative cardiovascular complications. Perioperative statin therapy was associated with an improvement in postoperative cardiovascular outcome and a reduction in serum lipid levels and levels of inflammation markers.