基础医学与临床 ›› 2021, Vol. 41 ›› Issue (7): 1039-1042.

• 临床研究 • 上一篇    下一篇

妇科腹腔镜手术局部脑氧饱和度变化趋势及其相关因素定量分析

王维嘉1,2,张宁晨3,张越伦2,龚亚红4   

  1. 1. 北京协和医学院
    2. 北京协和医院
    3. 中国医学科学院北京协和医院
    4. 中国医学科学院&北京协和医院
  • 收稿日期:2020-07-13 修回日期:2020-11-05 出版日期:2021-07-05 发布日期:2021-06-17
  • 通讯作者: 龚亚红 E-mail:yh2087@163.com

Change trend and quantification of related factors of regional cerebral oxygenation during laparoscopic gynecological surgery in gynecology

Wei-Jia WANG1,2,3, 2,3, 1,Ya-Hong GONG   

  • Received:2020-07-13 Revised:2020-11-05 Online:2021-07-05 Published:2021-06-17
  • Contact: Ya-Hong GONG E-mail:yh2087@163.com

摘要: 目的 探究头低位妇科腹腔镜手术局部脑氧饱和度(rScO2)变化趋势,并对其影响因素进行定量分析。方法 收集2017年6月至2018年8月于北京协和医院行择期全麻下妇科腹腔镜手术患者的临床资料;利用样条模型和混合效应模型分析rScO2变化趋势及影响因素。结果 共48例患者纳入研究,rScO2随时间先降低后升高(P<0.01),3例患者出现有临床意义的rScO2降低。平均动脉压、收缩压和呼气末CO2(ETCO2)与rScO2正相关(P<0.05),气道峰压和体质量指数(BMI)与rScO2负相关(P<0.05)。其中BMI和ETCO2对rScO2影响程度较大,且将时间纳入统计模型后,BMI和ETCO2对rScO2影响随时间延长逐渐增加(P<0.05)。结论 头低位腹腔镜妇科手术中rScO2呈现先降低后逐渐升高的变化趋势。在各相关因素中,BMI和ETCO2对的rScO2影响更为显著,且随时间延长明显增加。

关键词: 局部脑氧饱和度, 腹腔镜手术, 头低位, 麻醉管理

Abstract: Objective To identify the time course of regional cerebral oxygen saturation (rScO2) during laparoscopic gynecological surgery and to quantify the effect of related factors. Methods Data from patients scheduled for elective laparoscopic gynecological surgery were collected and analyzed from June 2017 to Aug 2018 in Peking Union Medical College Hospital. Results Forty-eight ASA 1~2 patients were included. rScO2 presented a U-shaped trend over time with the spline model (P<0.01 for the non-linear association). Episodes of cerebral deoxygenation were observed in 3 patients during the declining period of rScO2. Mean blood pressure, systolic blood pressure and end-tidal CO2 (ETCO2) were positively associated rScO2 (P <0.05). Peak airway pressure (PAP) and body mass index (BMI) were negatively associated rScO2 (P <0.05). Compared with other factors, the effects of BMI and ETCO2 on rScO2 were greater and increased significantly over time(P<0.05). Conclusions During the laparoscopic gynecological surgery with trendelenburg position, rScO2 changed significantly over time. BMI and ETCO2 exhibited greater effects on rScO2, and the effects increased significantly over time.

Key words: Regional cerebral oxygen saturation, laparoscopic surgery, Trendelenburg position, anesthetic management

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