食管癌根治术单肺通气期间脑氧饱和度变化及其与术后谵妄的关系

目的 探讨食管癌根治术患者单肺通气(OLV)期间脑氧饱和度(rSO2)变化与术后谵妄(POD)的关系,以及rSO2与麻醉监测指标间的相关性.方法 随机选取安徽医科大学附属巢湖医院2016年4月至2017年2月期间拟行右侧OLV的食管癌根治术患者40例,应用无创脑氧饱和度监测仪监测并记录清醒状态(T1),OLV前5 min(T2),OLV后10 min(T3)、30 min(T4)、60 min(T5),OLV结束后15 min(T6)6个时间点的rSO2,同时记录相应时间点的平均动脉压(MAP)、呼气末二氧化碳分压(PETCO2)、脉搏氧饱和度(SPO2)、HR.术后3天内,采用谵妄评定量表(CAM)对患者进行谵妄评估,记录患者POD的发生情况;分析OLV期间rSO2的变化与POD间的关系,以及rSO2与MAP、PETCO2、HR间的相关性.结果 T3、T4、T5时rSO2较T1时下降,差异有统计学意义(P<0.05);T3、T4、T5之间rSO2差异无统计学意义(P>0.05);T1、T2之间rSO2差异无统计学意义(P>0.05);T6时rSO2回升至接近T1时水平,且与T1时rSO2相比,差异无统计学意义(P>0.05);两侧脑组织rSO2下降差异无统计学意义(P>0.05);术后共有6名患者发生POD,发病率15%,POD患者OLV期间rSO2下降比率与非POD患者比较,差异有统计学意义(P<0.05);OLV期间rSO2的下降与MAP、PETCO2、HR均无相关性(r=0.193、0.103、0.242,P<0.05);结论 食管癌根治术患者OLV期间rSO2出现下降,发生POD的患者,rSO2下降更显著.

Relationship between the changes of cerebral oxygen saturation during one-lung ventilation and postoperative delirium

Objective To study the relationship between postoperative delirium and the changes of cerebral oxygen saturation (rSO2 )during one -lung ventilation(OLV), and the correlation between rSO 2 and the monitoring parameters of anesthesia .Methods 40 e-sophagus cancer patients undergoing thoracic surgery and necessitating right OLV were randomly selected .The rSO2 , MAP, PETCO2 , and HR were recorded at the time points of room enter (T1 ), 5 min before OLV(T2 ), 10 min after OLV(T3 ), 30 min after OLV(T4 ), 60 min after OLV(T5 ), 15min after double lungs ventilation(T6 ).Observed and recorded the case of postoperative delirium during the patients , an-alyze the change of rSO 2 during OLV and the relationship between rSO 2 and postoperative delirium.Results compared with T1 , The rSO2 at T3 , T4 , T5 were decreased significantly(P <0.05).The rSO2 at T2 ,T6 have no difference with T 1.Postoperative delirium occurred in 6 pa-tients, compared with non -POD patients,the rSO2 decrease more significantly in POD patients.There was no correlation between rSO 2 and MAP, PETCO2 , HR.Conclusion The rSO2 of patients undergoing thoracic surgery decreased significantly during OLV .The rSO2 decrease more remarkable in POD patients.