摘要
目的探讨在无创脑氧饱和度(SctO_2)监视下麻醉维持期不同吸入氧浓度在腹腔镜妇科肿瘤术中的安全性及可行性。方法选择60例在南方医科大学附属中山市博爱医院择期行腹腔镜妇科肿瘤手术的患者为研究对象,分为A、B、C组,每组20例。麻醉维持期间吸入氧浓度分别为30%、50%、100%。常规监测有创平均动脉压(iMAP)、心率(HR)、心电图(ECG)及血氧饱和度(SpO_2)、呼气末二氧化碳分压(PetCO_2)、SctO_2、麻醉深度Narcotrend。记录麻醉诱导前(T-1)、气腹前(T_0)、气腹后5min(T_1)、气腹后60min(T_2)、气腹后120min(T_3)和关气腹后5min(T_4)的SctO_2、SpO_2、iMAP、动脉血氧分压(PaO_2)、动脉血pH(aPH)、动脉血二氧化碳分压(PaCO_2)、动脉血红蛋白(HGB)、气道峰压(PIP)、肺顺应性(CL)变化;比较T-1、T_4时的氧合指数(PaO_2/FiO_2)及肺内分流率Qs/Qt,以及术前1d、术后3d的简易精神状态检查量表(MMSE)评分。结果与C组比较,A、B组的术后清醒拔管时间明显减少(P<0.05),A、B组的术后清醒拔管时间差异无统计学意义(P>0.05)。3组患者T_0、T_1、T_2、T_3、T_4时aPH、HGB、PaCO_2、SpO_2、iMAP差异无统计学意义(P>0.05);C组不同时间点的SctO_2、PaO_2明显高于A、B组(P<0.01),B组明显高于A组(P<0.01);T-1时Qs/Qt差异无统计学意义(P>0.05),T_4时A、B组患者Qs/Qt明显低于C组(P<0.05)。3组患者术前1d、术后3d的MMSE评分差异无统计学意义(P>0.05)。结论麻醉维持期吸入30%、50%氧浓度的新鲜气体在腹腔镜妇科肿瘤术中安全可行,且具有一定的优越性。
Objective To investigate the safety and feasibility of three different concentrations of inhaled oxygen in laparoscopic gynecologic tumor operation during anesthesia maintenance by noninvasivecerebral oxygen saturation(SctO 2)monitoring.Methods Sixty patients undergoing elective laparoscopic gynecological tumor operation in the hospital were selected as the study subjects and divided into the group A,B and C according to the random number table,20 cases in each group.During anesthesia maintenance,the inhaled oxygen concentrations of the group A,B and C were 30%,50%and 100%respectively.The invasive mean arterial pressure(iMAP),heart rate(HR),ECG,blood oxygen saturation(SpO 2),carbon dioxide partial pressure in end expiratory gas(PetCO 2),noninvasive cerebral tissue oxygen saturation(SctO 2)and Narcotrend(NT)were conventionally monitored.Radial arterial blood was collected for conducting blood gas analysis before anesthesia induction(T-1),before pneumoperitoneum(T 0),at 5 min(T 1),60 mins(T 2),120 min(T 3)after pneumoperitoneum and at 5 min after pneumoperitoneum-closing(T 4).The changes of SctO 2,SpO 2,iMAP,PaO 2,aPH,PaCO 2,hemoglobin(HGB)and CL at T-1,T 0,T 1,T 2,T 3 and T 4;the oxygenation index(PaO 2/FIO 2)and intrapulmonary shunt rate(Qs/Qt)at T-1 and T 4 were calculated according to the formula;then the MMSE score were compared between on preoperative 1 d and on postoperative 3 d.Results Compared with the group C,the extubation time at postoperative awaking in the group A and B was reduced obviously(P<0.05),and the difference in the extubation time at postoperative awaking had no statistical signifi-cance(P>0.05).aPH,HGB,PaCO 2,SPO 2,iMAP,had no statistical difference among different time points(T 0,T 1,T 2,T 3,T 4,P>0.05);SctO 2,and PaO 2 at different time points in the group C were apparently higher than those in the group A and B(P<0.01);SctO 2 and PaO 2 at different time points in the group B were apparently higher than those in the group A(P<0.01).The Qs/Qt difference at T-1 had no statistically significant difference among 3 groups;Qs/Qt at T 4 in the group A and B was significantly lower than that in the group C,the difference was statistically significant(P<0.05).The MMSE score significant in 3 groups had no statistical significant between on preoperative 1 d and on postoperative 3 d.Conclusion Inhaling 30%,50%oxygen concentration of fresh gas during anesthesia maintenance stage is safe and feasible in laparoscopic gynecological tumor operation,moreover has a certain advantages.
作者
吴靦
周晓筠
徐飞
王晟
WU Mian;ZHOU Xiaojun;XU Fei;WANG Sheng(Southern Medical University,Guangzhou,Guangdong 510515,China;Affiliated Zhongshan Boai Hospital,Southern Medical University,Zhongshan,Guangdong 528400,China)
出处
《重庆医学》
CAS
2018年第25期3299-3303,共5页
Chongqing medicine
关键词
无创脑氧饱和度
麻醉维持期
吸入氧浓度
腹腔镜
妇科肿瘤
noninvasive cerebral tissue oxygen saturation
anesthesia maintenance period
concentration of oxygen inhalation
laparoscope
gynecologic neoplasms
