摘要
目的探讨呼气末二氧化碳分压(partial pressure of end-tidal carbon dioxide,PETCO_(2))监测在右美托咪定辅助镇静下老年患者经皮椎体成形术(percutaneous vertebroplasty,PVP)中的临床应用效果。方法回顾性选取2021年4月至2022年4月首都医科大学宣武医院收治的PVP老年患者130例,根据监护方法分为试验组(面罩吸氧+PETCO_(2)监测)和对照组(面罩吸氧),每组65例。手术体位均为俯卧位,术前两组均静脉给予右美托咪定0.3μg/kg,注药时间15 min,术中持续输注右美托咪定0.3~0.5μg/(kg·h)进行维持。试验组经面罩连接PETCO_(2)监测肺通气状态,并根据PETCO_(2)数值及波形变化进行相应干预;对照组仅面罩吸氧。记录试验组开始持续经面罩吸氧前的PETCO_(2),比较两组入室后(T_(0))、进行局部麻醉时(T_(1))、穿刺针到达椎体时(T_(2))、球囊扩张时(T_(3))、注射骨水泥时(T_(4))及手术结束时(T_(5))的HR、平均动脉压(mean arterial pressure,MAP)和SpO_(2);比较两组麻醉期间低氧血症(SpO_(2)<90%)、提醒辅助、改变头部姿势的监测情况,以及低血压、高血压、心动过速、心动过缓和呼吸抑制等相关不良反应发生率。结果T_(0)时,两组HR、MAP及SpO_(2)比较,差异均无统计学意义(P>0.05);T_(1)、T_(1)、T_(3)、T_(4)和T_(5)时,两组HR及MAP均较T_(0)时明显降低,差异有统计学意义(P<0.05),但两组间比较,差异均无统计学意义(P>0.05);T_(4)和T_(5)时,试验组SpO_(2)较T_(0)时明显升高[(98.23±0.32)%和(98.21±0.26)%比(97.32±0.31)%],且明显高于对照组各时点[(97.33±0.28)%和(97.43±0.46)%],差异均有统计学意义(P<0.05);T_(1)、T_(2)和T_(3)时,对照组SpO_(2)较T_(0)时明显降低[(96.12±0.35)%、(96.23±0.28)%和(96.42±0.31)%比(97.42±0.52)%],且明显低于试验组各时点[(97.34±0.28)%、(97.43±0.24)%和(97.23±0.26)%],差异均有统计学意义(P<0.05)。试验组低氧血症、提醒辅助、改变头部姿势的比例和呼吸抑制发生率�
Objective To investigate the clinical effect of partial pressure of end-tidal carbon dioxide(PETCO_(2))monitoring in elderly patients undergoing percutaneous vertebroplasty(PVP)assisted by dexmedetomidine.Methods A total of 130 elderly patients with PVP admitted to Xuanwu Hospital,Capital Medical University from April 2021 to April 2022were retrospectively selected.According to the monitoring method,they were divided into experimental group(mask oxygen inhalation+PETCO_(2)monitoring)and control group(mask oxygen inhalation),with 65 cases in each group.The operation positions were all prone.Both groups were given intravenous dexmedetomidine 0.3μg/kg before operation,the injection time was 15 min,and the maintenance was 0.3-0.5μg/(kg·h)during operation.The experimental group was connected to PETCO_(2)through the mask to monitor the state of pulmonary ventilation,and made corresponding interventions according to the PETCO_(2)value and waveform changes.The control group received oxygen only through the mask.PETCO_(2)of the experimental group before continuous oxygen inhalation through the mask was recorded,and the HR,mean arterial pressure(MAP)and SpO_(2)of the two groups were compared after entering the room(T_(0)),during local anesthesia(T_(1)),when the puncture needle reached the vertebral body(T_(2)),when the balloon expanded(T_(3)),when the bone cement was injected(T_(4))and at the end of the operation(T_(5)).The hypoxemia(SpO_(2)<90%),reminder assistance,head posture changes,and the incidence of adverse reactions such as hypotension,hypertension,tachycardia,bradycardia,and respiratory depression were compared between the two groups.Results At T_(0),there were no significant differences in HR,MAP and SpO_(2)between the two groups(P>0.05).At T_(1),T_(2),T_(3),T_(4)and T_(5),HR and MAP in the two groups were significantly lower than those of T_(0)(P<0.05),but there was no significant difference between the two groups(P>0.05).At T_(4)and T_(5),SpO_(2)in experimental group were significantly higher than those of
作者
李博然
马艳辉
王天龙
Li Boran;Ma Yanhui;Wang Tianlong(Department of Anesthesiology and Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《北京医学》
CAS
2022年第12期1098-1101,1107,共5页
Beijing Medical Journal
基金
北京市医院管理局临床医学发展专项——“扬帆”计划(ZYLX201818)。
关键词
经皮椎体成形术
右美托咪定
呼气末二氧化碳分压
镇静
老年
percutaneous vertebroplasty(PVP)
dexmedetomidine
partial pressure of end-tidal carbon dioxide(PETCO_(2))
sedation
elderly
