首页|沙滩椅体位及控制性降压下肩关节手术病人脑氧饱和度与脑部血流速度改变及其对术后神经认知的影响

沙滩椅体位及控制性降压下肩关节手术病人脑氧饱和度与脑部血流速度改变及其对术后神经认知的影响

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目的 分析沙滩椅体位及控制性降压下肩关节手术中脑氧饱和度(rScO2)与脑部血流速度的变化,及其对病人术后神经认知的影响.方法 选取拟于本院以沙滩椅体位接受肩关节手术治疗的病人60例,均为美国麻醉医师协会(ASA)分级Ⅰ、Ⅱ级,在静脉全身麻醉及控制性降压干预下,于麻醉前、麻醉并转入沙滩椅体位后5 min、手术开始时以及手术开始后每隔20 min直至手术结束进行rScO2、大脑中动脉血流速度(VMCA)和有创血压(心脏水平和耳道水平)的检测,并记录脑氧欠饱和事件(CDE)的发生.同时,于术前和术后24h对病人进行神经认知能力测试.结果 转入沙滩椅体位后所有病人的rScO2和VMCA相比麻醉前都有所下降.经历CDE的病人耳道水平平均动脉压、rScO2和VMCA均显著低于未经历CDE的病人,并且术后24h时连线测试成绩也更低,组间差异有统计学意义(P＜0.05).结论 对于ASA分级Ⅰ、Ⅱ级病人,沙滩椅体位及控制性降压下肩关节手术中部分病人的rScO2和VMCA较麻醉前显著下降并发生CDE,进而对术后神经认知产生不利影响.
Changes of Intraoperative Cerebral Oxygen Saturation and Cerebral Blood Flow Velocity in Shoulder Surgery under Beach Chair Position and Controlled Hypotension and Their Relationship with Postoperative Neurocognitive Function
Objective To analyze the changes of cerebral oxygen saturation(rScO2)and cerebral blood flow of patients experiencing shoulder surgery under beach chair position and controlled hypotension,as well as their relationship with postoperative neurocognitive function.Methods A total of 60 patients with Ⅰ or ⅡAmerican Society of Anesthesiologists(ASA)Grades scheduled for shoulder surgery using beach chair position in our hospital were included in the present work.During surgery,the patients took the beach chair position and were treated with intravenous general anesthesia accompanied by a deliberated pressure controlling scheme of hypotension,and measurements of rScO2,cerebral middle artery flow velocity(VMCA)and invasive arterial pressure(at heart level and at auditory meatus level)were performed prior to anesthesia induction,5 min after beach chair positioning,at the beginning of operation,and every 20 min thereafter.Moreover,neurocognitive tests were performed prior to and 24 h after surgery.Results For all the patients,both values of rScO2 and VMCA decreased 5 min after beach chair positioning.Compared to patients without CDEs,there were lower values of arterial pressures at auditory meatus level,rScO2,and VMCA in patients encountered CDEs when turned into beach chair position.Patients with CDEs also acquired worse trial making test results performed 24 h after surgery.The aforementioned inter-group differences were all statistically significant(P＜0.05).Conclusion A part of ASA Ⅰ and Ⅱ patients undergoing shoulder surgery under beach chair position and controlled hypotension exhibit significant decreases in rScO2 and VMCA compared with values before anesthesia and encounter intraoperative CDEs,which consequently impact postoperative neurocognitive function.

Shoulder surgeryBeach chair positionControlled hypotensionCerebral oxygen saturationCerebral blood flow velocityCerebral desaturation eventPostoperative cognitionTrial making test

何平、史炯、高杨、贺曼曼、董丽蕴、郭亚宁、陈永学

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邯郸市中心医院麻醉科,河北邯郸 056001

肩关节手术 沙滩椅体位 控制性降压 脑氧饱和度 脑部血流速度 脑氧欠饱和事件 术后神经认知 连线测试

河北省医学科学研究课题

20220019

2024

10.3969/j.issn.1674-8573.2024.01.006

骨科
华中科技大学同济医学院附属同济医院 中华医学会武汉分会

骨科

CSTPCD
影响因子：2.555
ISSN：1674-8573
年,卷(期)：2024.15(1)
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