妇科腹腔镜手术中局部脑氧饱和度变化趋势及其相关因素定量分析

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

妇科腹腔镜手术中局部脑氧饱和度变化趋势及其相关因素定量分析

王维嘉, 张宁晨, 张越伦, 龚亚红^*

中国医学科学院北京协和医学院北京协和医院麻醉科, 北京 100730

收稿日期:2020-07-13 修回日期:2020-11-20 出版日期:2021-07-05 发布日期:2021-06-17
通讯作者: *yh2087@163.com

Tendency and quantification of related factors of regional cerebral oxygenation during laparoscopic surgery in gynecology

WANG Wei-jia, ZHANG Ning-chen, ZHANG Yue-lun, GONG Ya-hong^*

Department of Anesthesiology, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China

Received:2020-07-13 Revised:2020-11-20 Online:2021-07-05 Published:2021-06-17
Contact: *yh2087@163.com

摘要/Abstract

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,ASA Ⅰ~Ⅱ级患者纳入研究,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rScO₂的影响更为显著,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 surgery with trendelenburg position in gynecology and to quantify the effect of related factors. Methods Data from patients scheduled for elective gynecological laparoscopic surgery were collected and analyzed from June 2017 to Aug 2018 in Peking Union Medical College Hospital. Spline and mixed-effects models were used to investigate the changing trend and affecting factors of rScO₂. Results Forty-eight ASA Ⅰ~Ⅱ 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 with rScO₂ (P＜0.05). Peak airway pressure (PAP) and body mass index (BMI) were negatively associated with rScO₂ (P＜0.05). Compared with other factors, the effects of BMI and ETCO₂ on rScO₂ were increased significantly over time(P＜0.05). Conclusions During the gynecological laparoscopic surgery with trendelenburg position, rScO₂ changes significantly over time. BMI and ETCO₂ exhibite greater effects on rScO₂, and the effects increase significantly over time.

Key words: regional cerebral oxygen saturation, laparoscopic surgery, trendelenburg position, anesthetic management

中图分类号:

R614

王维嘉, 张宁晨, 张越伦, 龚亚红. 妇科腹腔镜手术中局部脑氧饱和度变化趋势及其相关因素定量分析[J]. 基础医学与临床, 2021, 41(7): 1039-1042.

WANG Wei-jia, ZHANG Ning-chen, ZHANG Yue-lun, GONG Ya-hong. Tendency and quantification of related factors of regional cerebral oxygenation during laparoscopic surgery in gynecology[J]. Basic & Clinical Medicine, 2021, 41(7): 1039-1042.

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