胸腔镜下老年肺癌患者术中脑氧饱和度变化与PEEP水平相关性的研究

  目的  探讨胸腔镜老年肺癌患者术中使用不同水平呼气末正压(PEEP)与脑氧饱和度(rSO₂)变化的相关性。  方法  选取蚌埠医学院第一附属医院2019年10月—2020年2月老年胸腔镜肺叶切除患者60例，按入院先后顺序分为A组、B组、C组，每组20例。单肺通气时，3组患者潮气量(V_T)设为5 mL/kg，A、B、C组PEEP分别设为0、5、10 cm H₂O(1 cm H₂O=0.098 kPa)。观察记录患者麻醉诱导后15 min(T0)和单肺通气10 min(T1)、30 min(T2)、60 min(T3)及恢复双肺通气20 min(T4)5个时点的脉氧饱和度(SpO₂)、气道峰压(Ppeak)、肺动态顺应性(Cdyn)、氧分压(PaO₂)及脑氧饱和度数值(rSO₂)。  结果  B组rSO₂最小值，rSO₂平均值较A、C组明显升高(均P < 0.05)，B组rSO₂最大百分比较A、C组明显降低(均P < 0.05)。T2~T4时点B组rSO₂高于A、C组，其中C组高于A组(均P < 0.05)。T1~T4时点B组Ppeak较A、C组降低(均P < 0.05)。T1~T4时点B组Cydn高于A组，T1时点B组Cydn高于A、C组(均P < 0.05)。T2~T4时点B、C组PaO₂显著高于A组(均P < 0.05)，3组患者T0~T4时点SpO₂差异无统计学意义(均P>0.05)。  结论  胸腔镜老年肺癌切除术患者单肺通气时脑氧饱和度数值变化与PEEP水平具有相关性，且5 cm H₂O PEEP具有较好的rSO₂水平。 

Study on the correlation between cerebral oxygen saturation and PEEP level of thoracoscopic elderly patients with lung cancer

Objective To investigate the correlation between positive end-expiratory pressure(PEEP) and cerebral oxygen saturation(rSO2) in elderly patients with thoracoscopic lung cancer. Methods A total of 60 elderly patients with thoracoscopic lobectomy from October 2019 to February 2020 were selected from the First Affiliated Hospital of Bengbu Medical College. They were divided into group A, group B and group C according to the order of admission, with 20 patients in each group. In the case of one-lung ventilation, tidal volume(VT) was set at 5 mL/kg in the 3 groups, and PEEP was set at 0, 5, and 10 cm H2O in the A, B, and C groups, respectively. Pulse oxygen saturation(SpO2), airway peak pressure(Ppeak), pulmonary dynamic compliance(Cdyn), oxygen partial pressure(PaO2) and cerebral oxygen saturation values(rSO2) were observed and recorded at five time points after anesthesia induction: 15 min(T0), 10 min(T1), 30 min(T2), 60 min(T3), and 20 min(T4) after recovery of bilateral ventilation. Results The minimum and average values of rSO2 in group B was significantly higher than that in group A and C(all P<0.05), and the maximum percentage of rSO2 in group B was significantly lower than that in group A and C(all P<0.05). At the time point T2-T4, rSO2 in group B was higher than that in group A and C, with group C higher than that in group A(all P<0.05). At time point T1-T4, Ppeak in group B was lower than that in group A and C(all P<0.05). Cydn of group B at time T1-T4 was higher than that of group A, and that of group B at time T1 was higher than that of group A and C(all P<0.05). PaO2 in group B and C was significantly higher than that in group A at T2-T4(all P<0.05), and SpO2 showed no statistically significant difference between the three groups at T0-T4(all P>0.05). Conclusion There was a correlation between brain oxygen saturation value and PEEP level during single lung ventilation in elderly patients undergoing thoracoscopic lung resection for lung cancer, and PEEP level at 5 cm H2O had a better rSO2 level.