国际麻醉学与复苏杂志   2014, Issue (3): 9-9
    
脑氧饱和度监测在反屈氏位腹腔镜手术中的应用
刘清海, 王天龙1()
1.首都医科大学宣武医院
Variation characteristics of cerebral tissue oxygen saturation in the reverse Trendelenburg position during laparoscopic surgery.
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摘要：

目的 观察反屈氏位腹腔镜手术期间，患者无创局部脑氧饱和度(SCTO2,Cerebral tissue oxygen saturation)变化及特点。方法 选择择期行腹腔镜手术的胃肠道肿瘤患者20例，采用无创FORE-SIGHT近红外光仪监测双侧额部SCTO2，清醒状态下记录基础值(T0)，分析CO2气腹前（T1）以及30°反屈氏位气腹下每隔15min（T2~T9）PETCO2及SCTO2数据，同期采集患者的MAP和体温，以及术前、术后的血红蛋白浓度。计算气腹期间SCTO2的变化幅度。随访术后神经系统并发症。结果 1.患者麻醉前清醒状态下SCTO2基础值：左侧为72±6%、右侧为72±4%，气腹前：左侧75±6%、右侧74±5%。气腹75min后SCTO2增高达峰值：左侧为84±5%、右侧为81±4%，均较基础值显著增加（P<0.05）。2. 气腹期间，与气腹前比较SCTO2左侧增幅8.31±5.77%，右侧增幅8.21±5.69%，增幅最大值左侧达15.49%，右侧达17.14%。3. CO2气腹期间PETCO2的变化：气腹前为33.78±2.33mmHg，气腹15min后达到38.44±2.83mmHg，75min后达峰值40.75±2.22mmHg，均较气腹前显著增加（P<0.05）。4.各时点MAP、体温、血红蛋白浓度间无统计学差异。结论 反屈氏位CO2气腹条件下SCTO2持续增高，与CO2气腹所致的高碳酸血症性脑血管扩张及脑血流增加、吸入氧浓度升高有关，适度高碳酸血症有益于CO2气腹下脑氧供需平衡的维持。
关键词： 脑氧饱和度，二氧化碳气腹，腹腔镜手术
Abstract:

Abstract：Objective To observe the variation characteristics of cerebral tissue saturation in the reverse Trendelenburg position during laparoscopic surgery. Method Patients with gastric cancer undergoing laparoscopic surgery were monitored intraoperatively using the FORE-SIGHT cerebral oximeter . Two sensors were placed on the subject's forehead bilaterally for continuous monitoring of SCTO2.The subjects were in the 30°reverse Trendelenburg position during surgery.Datas of SCTO2, PETCO2 ,MAP and Temperature recorded every fifteen minutes after carbon dioxide pneumoperitoneum were analyzed . Meanwhile, concentration of hemoglobin are examinated at preoperation and postoperation. All patients were followed up for neurological complications. Result 20 patients were monitored. The patients’ age ranged from 34 t0 80 yr.The base value of SCTO2 was 72±6% on the left sensor,and 72±4% on the right sensor.The SCTO2 maximum values were 84±5% on the left sensor,and 81±4% on the right sensor after 75 minutes carbon dioxide pneumoperitoneum. During pneumoperitoneum the SCTO2 values increased by 8.31±5.77% on the left sensor ,and 8.21±5.69% on the right sensor. The maximum increasing amplitudes of SCTO2 were 15.49% (left) and 17.14%(right) respectively during CO2 pneumoperitoneum.The PETCO2 values before pneumoperitoneum, 15min and 75min pneumoperitoneum were 33.78±2.33mmHg, 38.44±2.83mmHg and 40.75±2.22mmHg ,respectively. There were no significant difference in datas of MAP,Temperature and hemoglobin concentration.Neurological complications of postoperation were not found.Conclusion The SCTO2 values increased under reverse trendelenburg and carbon dioxide pneumoperitoneum because of the raised FiO2 and cerebral blood flow due to hypercapnia which can contributed to maintain cerebral oxygen supply and demand balance .
Key words: cerebral tissue oxygen saturation,carbon dioxide pneumoperitoneum,laparoscopic surgery