胸腔镜下老年肺癌患者术中脑氧饱和度变化与PEEP水平相关性的研究

于汝; 梁启胜; 刘磊; 符炜; 姜玉玉; 王康武

doi:10.16766/j.cnki.issn.1674-4152.001764

胸腔镜下老年肺癌患者术中脑氧饱和度变化与PEEP水平相关性的研究

doi: 10.16766/j.cnki.issn.1674-4152.001764

蚌埠医学院第一附属医院麻醉科，安徽蚌埠 233004

基金项目:

安徽省教育厅高校自然科学研究重点项目 KJ2019A0366

详细信息

通讯作者:
梁启胜，E-mail：bbyemenlqs@126.com

中图分类号: R616.5 R614.1
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- 文章访问数: 183
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- 被引次数: 0
出版历程
- 收稿日期: 2020-06-21
- 网络出版日期: 2022-02-19

Study on the correlation between cerebral oxygen saturation and PEEP level of thoracoscopic elderly patients with lung cancer

Department of Anesthesiology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨胸腔镜老年肺癌患者术中使用不同水平呼气末正压(PEEP)与脑氧饱和度(rSO₂)变化的相关性。方法选取蚌埠医学院第一附属医院2019年10月—2020年2月老年胸腔镜肺叶切除患者60例，按入院先后顺序分为A组、B组、C组，每组20例。单肺通气时，3组患者潮气量(V_T)设为5 mL/kg，A、B、C组PEEP分别设为0、5、10 cm H₂O(1 cm H₂O=0.098 kPa)。观察记录患者麻醉诱导后15 min(T0)和单肺通气10 min(T1)、30 min(T2)、60 min(T3)及恢复双肺通气20 min(T4)5个时点的脉氧饱和度(SpO₂)、气道峰压(Ppeak)、肺动态顺应性(Cdyn)、氧分压(PaO₂)及脑氧饱和度数值(rSO₂)。结果 B组rSO₂最小值，rSO₂平均值较A、C组明显升高(均P < 0.05)，B组rSO₂最大百分比较A、C组明显降低(均P < 0.05)。T2~T4时点B组rSO₂高于A、C组，其中C组高于A组(均P < 0.05)。T1~T4时点B组Ppeak较A、C组降低(均P < 0.05)。T1~T4时点B组Cydn高于A组，T1时点B组Cydn高于A、C组(均P < 0.05)。T2~T4时点B、C组PaO₂显著高于A组(均P < 0.05)，3组患者T0~T4时点SpO₂差异无统计学意义(均P>0.05)。结论胸腔镜老年肺癌切除术患者单肺通气时脑氧饱和度数值变化与PEEP水平具有相关性，且5 cm H₂O PEEP具有较好的rSO₂水平。
- 呼气末正压 /
- 单肺通气 /
- 胸腔镜手术 /
- 肺功能 /
- 局部脑氧饱和度
Abstract: Objective To investigate the correlation between positive end-expiratory pressure (PEEP) and cerebral oxygen saturation (rSO₂) in elderly patients with thoracoscopic lung cancer. Methods A total of 60 elderly patients with thoracoscopic lobectomy from October 2019 to February 2020 were selected from the First Affiliated Hospital of Bengbu Medical College. They were divided into group A, group B and group C according to the order of admission, with 20 patients in each group. In the case of one-lung ventilation, tidal volume (V_T) was set at 5 mL/kg in the 3 groups, and PEEP was set at 0, 5, and 10 cm H₂O in the A, B, and C groups, respectively. Pulse oxygen saturation (SpO₂), airway peak pressure (Ppeak), pulmonary dynamic compliance (Cdyn), oxygen partial pressure (PaO₂) and cerebral oxygen saturation values (rSO₂) were observed and recorded at five time points after anesthesia induction: 15 min (T0), 10 min (T1), 30 min (T2), 60 min (T3), and 20 min (T4) after recovery of bilateral ventilation. Results The minimum and average values of rSO₂ in group B was significantly higher than that in group A and C (all P < 0.05), and the maximum percentage of rSO₂ in group B was significantly lower than that in group A and C (all P < 0.05). At the time point T2-T4, rSO₂ in group B was higher than that in group A and C, with group C higher than that in group A (all P < 0.05). At time point T1-T4, Ppeak in group B was lower than that in group A and C (all P < 0.05). Cydn of group B at time T1-T4 was higher than that of group A, and that of group B at time T1 was higher than that of group A and C (all P < 0.05). PaO₂ in group B and C was significantly higher than that in group A at T2-T4 (all P < 0.05), and SpO₂ showed no statistically significant difference between the three groups at T0-T4 (all P>0.05). Conclusion There was a correlation between brain oxygen saturation value and PEEP level during single lung ventilation in elderly patients undergoing thoracoscopic lung resection for lung cancer, and PEEP level at 5 cm H₂O had a better rSO₂ level.
- End-expiratory pressure /
- One-lung ventilation /
- Thoracoscopic surgery /
- Pulmonary function /
- Regional cerebral oxygen saturation

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表 1 3组老年肺癌患者术前一般情况比较(x ±s)

组别	例数	年龄(岁)	BMI	ASA例数(Ⅱ/Ⅲ)	术前Hb(g/L)	FEV1/FVC(%)	OLV时间(min)
A组	20	67.05±3.43	23.13±2.68	9/11	118.00±13.01	81.54±4.75	70.65±4.12
B组	20	66.68±3.30	23.15±2.85	10/10	115.40±11.89	80.52±4.32	70.35±5.94
C组	20	66.38±3.46	23.97±2.89	8/12	118.40±11.30	79.90±4.06	70.65±6.29
统计量		0.291^a	0.586^a	0.082^b	0.326^a	0.706^a	0.020^a
P值		0.820	0.560	0.817	0.723	0.498	0.981
注：^a为F值，^b为χ²值。

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表 2 3组老年肺癌患者不同时间点Ppeak比较(x ±s)

组别	例数	T0	T1	T2	T3	T4	F值	P值
A组	20	15.00±1.56	20.45±1.63^a	21.05±2.31^a	20.10±1.37^a	17.40±1.54^a	65.857	< 0.001
B组	20	14.25±1.77	19.15±1.81	19.30±2.00	18.50±1.91	16.15±2.13	7.472	< 0.001
C组	20	14.63±1.84	20.30±1.78^a	20.75±2.07^a	19.80±1.57^a	17.70±1.68^a	54.017	< 0.001
F值		0.943	3.320	3.875	5.425	4.152
P值		0.396	0.043	0.027	0.007	0.021
注：与同时间点B组比较，^aP < 0.05。

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表 3 3组老年肺癌患者各时间点肺动态顺应性比较(x ±s)

组别	例数	T0	T1	T2	T3	T4	F值	P值
A组	20	56.10±6.48	38.20±4.32^a	36.05±4.17^ab	33.30±3.77^ab	41.45±3.44^ab	279.872	< 0.001
B组	20	54.85±6.96	45.85±7.21	43.00±7.65	43.65±1.41	47.95±6.13	23.669	< 0.001
C组	20	55.90±4.72	41.55±6.05^a	43.25±7.15	43.15±6.52	45.05±5.74	164.056	< 0.001
F值		0.240	8.215	7.891	18.307	7.734
P值		0.787	0.001	0.001	< 0.001	0.001
注：与同时间点B组比较，^aP < 0.05;与同时间点C组比较，^bP < 0.05。

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表 4 3组老年肺癌患者各时间SpO₂、PaO₂、rSO₂比较(x ±s)

组别	例数	SpO₂(%)					F值	P值
组别	例数	T0	T1	T2	T3	T4	F值	P值
A组	20	98.05±1.08	96.35±1.18	93.70±0.73	93.75±0.79	95.90±0.97	123.973	< 0.001
B组	20	98.35±0.81	96.45±1.05	94.00±0.65	94.05±0.60	96.15±0.81	101.435	< 0.001
C组	20	98.05±0.82	96.25±1.02	93.65±0.59	93.90±0.64	96.00±0.73	104.273	< 0.001
F值		0.706	0.170	1.651	0.968	0.447
P值		0.498	0.844	0.201	0.386	0.642

组别	例数	PaO₂(mm Hg)					F值	P值
组别	例数	T0	T1	T2	T3	T4	F值	P值
A组	20	451.15±14.43	410.60±16.36	215.65±39.56^ab	253.65±34.24^ab	310.80±34.95^ab	280.788	< 0.001
B组	20	450.80±12.36	414.65±13.32	255.05±32.79	301.15±31.96	349.60±26.73	210.131	< 0.001
C组	20	452.30±16.00	412.05±16.99	237.90±26.15	287.00±45.24	334.20±29.52	220.294	< 0.001
F值		0.060	0.344	7.043	8.415	8.153
P值		0.942	0.710	0.002	0.001	0.001

组别	例数	rSO₂(%)					F值	P值
组别	例数	T0	T1	T2	T3	T4	F值	P值
A组	20	75.50±3.05	68.15±3.40^a	66.25±3.20^ab	65.75±2.24^ab	69.45±2.24^ab	39.264	< 0.001
B组	20	77.85±4.55	71.65±3.25	70.85±3.56	70.20±3.07	74.10±2.93	17.203	< 0.001
C组	20	76.55±3.88	69.00±3.39	68.60±3.50^a	67.80±2.70^a	71.85±3.26^a	24.397	< 0.001
F值		1.840	5.944	9.014	13.655	11.603
P值		0.168	0.005	< 0.001	< 0.001	< 0.001
注：与同时间点B组比较，^aP < 0.05；与同时间点C组比较, ^bP < 0.05。

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表 5 3组老年肺癌患者术中rSO₂min、rSO₂max%、rSO₂avg比较(x ±s)

组别	例数	rSO₂min	rSO₂max%	rSO₂avg
A组	20	66.65±2.72^ab	13.95±4.16^ab	71.70±6.04^ab
B组	20	71.70±4.50	8.90±1.77	76.40±2.66
C组	20	69.15±4.27^a	11.45±2.72^a	73.75±2.15^a
F值		8.342	13.722	8.736
P值		0.001	< 0.001	0.001
注：与B组比较，^aP < 0.05；与C组比较, ^bP < 0.05。

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