| 程磊,蒋宇,郑立东.脑氧监测目标导向管理对老年胸腔镜食管癌根治术病人术后谵妄的影响[J].安徽医药,2021,25(6):1190-1193. |
| 脑氧监测目标导向管理对老年胸腔镜食管癌根治术病人术后谵妄的影响 |
| Effect of goal-directed management of cerebral oxygen monitoring on postoperative delirium in elderly patients undergoing thoracoscopic radical esophagectomy |
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| DOI：10.3969/j.issn.1009-6469.2021.06.032 |
| 中文关键词: 食管肿瘤 食管切除术 麻醉恢复期 局部脑氧饱和度 单肺通气 术后谵妄 老年人 |
| 英文关键词: Esophageal neoplasms Esophagectomy Anesthesia recovery period Regional cerebral oxygen saturation One-lung ventilation Postoperative delirium Aged |
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| 中文摘要: |
| 目的观察连续局部脑氧饱和度( rScO2)监测目标导向的麻醉管理对老年胸腔镜食管癌根治术病人术后谵妄的影响。方法 2019年 1月至 2020年 1月六安市人民医院择期全麻联合椎旁神经阻滞下行胸腔镜下食管癌根治术的老年病人 78例，美国麻醉医师协会( ASA)分级 Ⅱ或Ⅲ级，采用随机数字表法分为观察组( 39例)和对照组( 39)例。对照组常规麻醉监测管理，观察组在对照组的基础上增加 rScO2监测的麻醉管理，维持 rScO2>65%或较基础值下降不超过 20%。观察比较两组以下指标:术后 3d内谵妄的发生情况、麻醉恢复室(PACU)停留时间以及住院时间和术后并发症；术中相关麻醉药物的使用；入室清醒不吸氧(T1)、诱导后侧卧位双肺通气 10 min(T2)、侧卧位单肺通气 30 min(T3)和拔管后 1 min(T4)的心率、平均动脉压( MAP)、乳酸、麻醉深度和动脉血二氧化碳分压( PaCO2)。结果观察组 2例病人因术中脑氧饱和度下降幅度太大无法纠正而剔除，最终纳入 76例。与对照组相比，观察组在 T3、T4时点 MAP升高( P<0.05)在 T3、T4时点乳酸值降低( P<0.05)术后谵妄发生率［5.4%(2/37)比 25.6%(10/39)］和肺部并发症［0%(0/37)比 12.8%(10/39］显著降低( P<0.05)，PACU停留时住院时间均较)，间及，短(P<0.05)。结论以 rScO2监测目标导向的麻醉管理可以减少术后谵妄等并发症的发生，缩短住院时间。 |
| 英文摘要: |
| Objective To observe the effect of goal-directed anesthesia management with continuous rScO2 monitoring on postoperative delirium in elderly patients underwent thoracoscopic radical esophagectomy.Methods A total of 78 patients, falling into AmericaSociety of Anesthesiologists (ASA) physical status Ⅱ or Ⅲ, scheduled for elective thoracoscopic radical esophagectomy under generalanesthesia combined with paravertebral nerve block in Lu′an People′s Hospital from January 2019 to January 2020, were assigned intotwo groups using a random number table: observation group (n=39) and control group (n=39). Routine anesthesia monitoring management was performed in the control group, and anesthesia management with rScO2 monitoring was added to routine anesthesia monitoring management in the observation group to maintain rScO2 > 65% or no more than 20% decrease from the baseline value. The following indicators were observed and compared between the two groups: the occurrence of delirium within 3 days after surgery, postanesthesiacare unit (PACU) stay, length of hospital stay and postoperative complications; the use of intraoperative related anesthetic drugs; heartrate (HR), mean arterial pressure (MAP), lactic acid (Lac), bispectral index (BIS) and partial pressure of carbon dioxide (PaCO2) at thetime of being awake without oxygen inhalation (T1), 10 minutes of ventilation in the lateral decubitus position after induction (T2), 30minutes of one-lung ventilation in the lateral decubitus position (T3) and 1 minute after extubation (T4).Results Two cases were excluded due to the decrease in intraoperative cerebral oxygen saturation too much to be corrected. Seventy-six cases were included in the end. Compared with the control group, MAP increased at T3 and T4 (P<0.05), and Lac decreased at T3 and T4 (P<0.05). The incidences of postoperative delirium [5.4% (2/37) vs. 25.6% (10/39)] and pulmonary complications [0% (0/37)) vs. 12.8% (10/39)] were significantly lower (P<0.05). PACU stay time and the length of hospital stay were shortened (P<0.05).Conclusion Goal-directed anesthesia management with rScO2 monitoring can reduce the occurrence of complications such as postoperative delirium and shorten the length of hospital stay. |
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