摘要
目的探讨局部脑氧饱和度(regional cerebral oxygen saturation,rSO_(2))监测对微创冠脉旁路移植术患者围术期的安全性和可行性。方法选取2017年1月-2019年8月洛阳市中心医院收治的75例微创冠脉旁路移植术患者,随机将患者分为对照组(37例)和试验组(38例)。两组患者常规麻醉诱导维持,监测血气、血压、心率(heartrate,HR)、氧饱和度(oxygen saturation,SpO2)等。试验组术中采用rSO_(2)监测,维持rSO_(2)不低于绝对值50%或不低于基础值20%。在T_(1)(气管插管前)、T_(2)(单肺通气30 min,吻合血管前)、T_(3)(双肺通气即刻)、T_(4)(术后6 h)、T_(5)(术后3 d)5个时间点采集动脉血,记录血气、血压、HR、SpO2等。运用简易精神状态检查量表(mini-mental state examination,MMSE)评估患者术前、术后6 h、1 d、3 d的认知功能。并记录术后6 h、12 h、24h、48h患者谵妄(postoperative delirium,POD)发生情况。结果试验组苏醒时间明显低于对照组,差异有统计学意义(P<0.05);试验组术后6 h、1 d MMSE评分明显高于对照组,差异有统计学意义(P<0.05),两组术前、术后3 d MMSE评分比较,差异无统计学差异(P<0.05);试验组术后6 h、12 h、24 h、48 h共3例患者发生POD,明显少于对照组,差异有统计学意义(P<0.05)。结论局部脑氧饱和度监测在微创冠脉旁路移植术中,能够增加患者术后MMSE评分,降低患者术后POD的发生,使手术更安全。
Objective To explore the safety and feasibility of regional cerebral oxygen saturation(rSO_(2))monitoring for patients undergoing minimally invasive coronary artery bypass grafting during the perioperative period.Methods From January 2017 to August 2019,75 cases of minimally invasive coronary artery bypass grafting were selected,and the patients were randomly divided into the control group and the test group.The two groups of patients were maintained under conventional anesthesia induction,and monitored under blood gas,blood pressure,heart rate(HR),and oxygen saturation(SpO2).The experimental group was used rSO_(2) monitoring during the operation to maintain rSO_(2) not less than 50%of the absolute value or not less than 20%of the basic value.Arteries blood were collected at 5 time points T_(1)(before tracheal intubation),T_(2)(30 min for single lung ventilation,before blood vessel anastomosis),T_(3)(immediate ventilation for both lungs),T_(4)(6 h after surgery),and T_(5)(3 days after surgery).Blood pressure,blood gas,oxygen saturation,HR,SpO2 were recorded.The Simple Mental State Examination Scale(MMSE)was used to evaluate the patient’s cognition at various points in the perioperative period(before surgery,6 h,1 d,3 d after surgery).And the occurrence of postoperative delirium(POD)at 6 h,12 h,24 h,and 48 h were recorded postoperatively.Results The awakening time of the experimental group was significantly shorter than that of the control group(P<0.05).The MMSE scores of the experimental group were significantly higher than those of the control group(P<0.05)at 6 h and 1 d after the operation.There was no statistical difference between the preoperative and 3 d postoperative MMSE scores of the two groups(P>0.05).A total of 3 patients in the test group had POD at 6 h,12 h,24 h and 48 h postoperatively,which was significantly less than the control group(P<0.05).Conclusion Monitoring of local cerebral oxygen saturation in minimally invasive coronary artery bypass grafting can increase the postoperative MMSE score of
作者
郜扬
张占琴
胡杰
陈兴澎
何勇
屈航英
梁哲勇
陈强
GAO Yang;ZHANG Zhanqin;HU Jie;CHEN Xingpeng;HE Yong;QU Hangying;LIANG Zheyong;CHEN Qiang(Department of Cardiovascular Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an Shaanxi 710061,China;Heart Center of Luoyang Central Hospital,Luoyang Henan 471009,China)
出处
《转化医学杂志》
2022年第3期159-163,共5页
Translational Medicine Journal
基金
河南省科技发展项目(192102310128)
河南省医学科技公关项目(2018020904)。
关键词
脑氧饱和度
微创冠脉旁路移植术
简易精神状态检查量表评分
谵妄
Cerebral oxygen saturation
Minimally invasive coronary artery bypass grafting
Mini-mental state examination score
Postoperative delirium(POD)
