老年食管癌患者单肺通气期间局部脑氧饱和度的变化及影响因素分析

摘要

Objective To study the changes and influencing factors in regional cerebral oxygen saturation ( rSO2) in older esophageal cancer patients undergoing SLV during thoracic surgery. Methods 20 esophageal cancer patients, ASA Ⅱ~ Ⅲ grade, age≥65 years old, undergoing thoracic surgery and necessitating SLV were randomly selected, double-lumen endotracheal tube was used for SLV, INVOS Cerebral Oximeter was used to measure regional cerebral oxygen saturation (rSO2) from the awake state to extubation phase, the bispectral index ( BIS) , standard monitoring parameters and blood gas analysis was observed and recorded at the corresponding time points. Results (J)Pa-tients showed a regional cerebral oxygen saturation ( rSO2) of (66. 5 ± 2. 2)% in the awake state, Which decreased to (56. 2 ±2. 6) % after anesthesia induced and supine with two lung ventilation, During SLV the rSO2 decreased to a minimum value of(50.4±2.2)%, which recover to(62.2±2.1)% after extubation ; During SLV, all patients had decrease of more than 18% of the initial rSO2, 70% ( 14/20) of patients had a decrease of more than 20% of the initial rSO2, 30% ( 6/20) of patients had a decrease of more than 25% of the initial rSO2 ; There are 30% (6/20) of the patients who rSO2 value less than 50% during SLV. (g) The decrease in rSO2 was not correlated with any standard clinical monitoring parameters, which include BIS, SpO2, MAP, body temperature, PaCO2 , PaO2, Hct, Hgb, SaO2. Conclusions Elderly patients undergoing SLV during thoracic surgery seems to be associated with a significant decrease of rSO2 in the majority of patients, There was no significant correlation between routine clinical monitoring parameters and the decrease of rSO2.%目的 研究老年食管癌患者开胸手术单肺通气期间局部脑氧饱和度( rSO2)的变化及影响因素.方法 随机选取20例年龄大于65岁,拟静吸复合全身麻醉下行左后外切口开胸食管癌根治术的患者,采用双腔支气管导管进行开胸后单肺通气(SLV)管理,应用脑氧饱和度监测仪监测从清醒状态到气管拔管阶段的脑氧饱和度变化,并观察记录脑电双频指数( BIS)和标准监测参数,在对应时间点进行血气分析.结果 ①清醒状态时测定局部脑氧饱和度( rSO2)为66.5％±2.2％,麻醉诱导后侧卧位双肺通气时rSO2为56.2％±2.6％,在SLV期间rSO2降为50.4％±2.2％,拔管时rSO2为62.2％±2.1％；在SLV期间,所有患者rSO2下降≥18％,70％ (14/20)的患者降幅超过20％,30％ (6/20)的患者降幅超过25％；SLV期间rSO2绝对值低于50％的患者占30％ (6/20).②rSO2的降低与SLV时间、BIS值、SpO2、MAP、体温、PaCO2、PaO2、Hcr、Hgb、SaO2等临床监测参数均无相关性.结论 老年食管癌患者单肺通气期间均发生脑氧饱和度的降低,有30％的患者rSO2绝对值低于50％；rSO2的降低与常规临床监测参数间无明显相关性.