摘要
目的:通过实时监测沙滩椅位肩关节镜手术病人术中脑氧饱和度(rSO_(2))变化,探讨超声引导下星状神经节阻滞(SGB)对允许性高碳酸血症改善脑氧供需平衡的影响。方法:择期行肩关节镜手术病人86例,采用随机数字表法分为SGB组与对照组(CN组),各43例。2组均于术侧C6横突前结节水平行超声引导下SGB操作,SGB组注射0.25%盐酸罗哌卡因+1%盐酸利多卡因混合液6 mL,CN组注射等容量0.9%氯化钠溶液。2组病人均采用快速诱导气管插管法行气管插管后机械辅助呼吸。随后改为沙滩椅位进行手术,术中调整通气策略逐渐升高呼气末二氧化碳分压(P_(ET)CO_(2))。分别于入室平卧位10 min(T_(0))、SGB后10 min(T_(1))、诱导后平卧位10 min(T_(2))、诱导后沙滩椅位10 min(T_(3))、手术开始P_(ET)CO_(2)35~40 mmHg水平稳定30 min(T_(4))和P_(ET)CO_(2)45~50 mmHg水平稳定30 min(T_(5))时记录各组病人脑氧饱和度(rSO_(2)),记录术中大脑去饱和事件(CDE)发生情况,恶心、呕吐的发生情况和血管活性药物使用情况。结果:T_(3)~T_(5)时,SGB组术侧rSO_(2)均高于CN组(P<0.05~P<0.01);2组间非术侧rSO_(2)差异均无统计学意义(P>0.05)。SGB组和CN组内不同时间点比较,随着时间的推移,术侧及非术侧rSO_(2)变化差异有统计学意义(P<0.01)。2组病人术前1天、术后第1天的简易精神状态检查评分、术后恶心、呕吐的发生情况以及CDE发生率差异均无统计学意义(P>0.05)。结论:肩关节镜手术沙滩椅位引起的rSO_(2)水平下降,可通过调整通气后的允许性高碳酸血症得到有效改善,且这种改善在术侧SGB作用更能有效地体现。
Objective:To investigate the effect of ultrasound-guided stellate ganglion block(SGB)on improvement of cerebral oxygen supply-demand balance in patients with permissible hypercapnia through real-time monitoring of intraoperative changes in cerebral oxygen saturation(rSO_(2))during beach chair shoulder arthroscopic surgery.Methods:A total of 86 patients undergoing elective shoulder arthroscopic surgery were randomly divided into an SGB group and a control group(CN group)using a random number table method,with 43 patients in each group.Both groups underwent ultrasound-guided SGB surgery at the level of the C6 transverse tubercle on the surgical side.The SGB group was injected with a mixture of 0.25%ropivacaine hydrochloride and 1%lidocaine hydrochloride in 6 mL,while the CN group was injected with an equal volume of 0.9%sodium chloride solution.Both groups underwent rapid induction tracheal intubation and mechanical assisted breathing after tracheal intubation.Later,the operation was performed in the beach chair position,and the ventilation strategy was adjusted during the operation to gradually increase P_(ET)CO_(2).The rSO_(2) levels of patients in each group at 10 minutes after entering the room(T_(0)),10 minutes after SGB(T_(1)),lie flat for 10 minutes after induction(T_(2)),10 minutes of beach chair position after induction(T_(3)),30 minutes after stabilization of P_(ET)CO_(2)35-40 mmHg levels at the beginning of surgery(T_(4)),and 30 minutes after stabilization of P_(ET) CO_(2)45-50 mmHg levels at the beginning of surgery(T_(5))were recorded.The occurrence of cerebral desaturation events(CDE)during surgery,the occurrence of nausea and vomiting,and the use of vasoactive drugs were recorded.Results:At T_(3)-T_(5),the rSO_(2) on the surgical side of the SGB group was higher than that of the CN group(P<0.05 to P<0.01).There was no statistically significant difference in non-surgical rSO_(2) between the two groups(P>0.05).Compared at different time points within the SGB and CN groups,there was a statistically sign
作者
袁晨
钱美娟
赵李红
姜文强
杨芬
谢阳
YUAN Chen;QIAN Mei-juan;ZHAO Li-hong;JIANG Wen-qiang;YANG Fen;XIE Yang(Department of Anesthesiology,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou Jiangsu 215002,China)
出处
《蚌埠医学院学报》
CAS
2023年第12期1661-1665,共5页
Journal of Bengbu Medical College
基金
江苏省科技厅社会发展重点研发项目(BE2017661)
上海市闵行区卫生健康委员会科研项目(2023MW69)。
关键词
肩关节镜手术
星状神经节阻滞
允许性高碳酸血症
脑氧饱和度
沙滩椅位
shoulder arthroscopic surgery
stellate ganglion block
permissible hypercapnia
cerebral oxygen saturation
beach chair position
