术中近红外光谱监测下沙滩椅位和侧卧位行肩关节镜手术时脑氧饱和度降低事件。
Cerebral oxygen desaturation events assessed by near-infrared spectroscopy during shoulder arthroscopy in the beach chair and lateral decubitus positions.
机构信息
Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, 2650 Ridge Ave., Evanston, IL 60201, USA.
出版信息
Anesth Analg. 2010 Aug;111(2):496-505. doi: 10.1213/ANE.0b013e3181e33bd9. Epub 2010 May 27.
BACKGROUND
Patients undergoing shoulder surgery in the beach chair position (BCP) may be at risk for adverse neurologic events due to cerebral ischemia. In this investigation, we sought to determine the incidence of cerebral desaturation events (CDEs) during shoulder arthroscopy in the BCP or lateral decubitus position (LDP).
METHODS
Data were collected on 124 patients undergoing elective shoulder arthroscopy in the BCP (61 subjects) or LDP (63 subjects). Anesthetic management was standardized in all patients. Regional cerebral tissue oxygen saturation (Scto(2)) was quantified using near-infrared spectroscopy. Baseline heart rate, mean arterial blood pressure, arterial oxygen saturation, and Scto(2) were measured before patient positioning and then every 3 minutes for the duration of the surgical procedure. Scto(2) values below a critical threshold (> or = 20% decrease from baseline or absolute value < or = 55% for >15 seconds) were defined as a CDE and treated using a predetermined protocol. The number of CDEs and types of intervention used to treat low Scto(2) values were recorded. The association between intraoperative CDEs and impaired postoperative recovery was also assessed.
RESULTS
Anesthetic management was similar in the BCP and LDP groups, with the exception of more interscalene blocks in the LDP group. Intraoperative hemodynamic variables did not differ between groups. Scto(2) values were lower in the BCP group throughout the intraoperative period (P < 0.0001). The incidence of CDEs was higher in the BCP group (80.3% vs 0% LDP group), as was the median number of CDEs per subject (4, range 0-38 vs 0, range 0-0 LDP group, all P < 0.0001). Among all study patients without interscalene blocks, a higher incidence of nausea (50.0% vs 6.7%, P = 0.0001) and vomiting (27.3% vs 3.3%, P = 0.011) was observed in subjects with intraoperative CDEs compared with subjects without CDEs.
CONCLUSIONS
Shoulder surgery in the BCP is associated with significant reductions in cerebral oxygenation compared with values obtained in the LDP.
背景
在沙滩椅位（BCP）下行肩部手术的患者可能由于脑缺血而出现不良神经事件。在这项研究中，我们旨在确定在 BCP 或侧卧位（LDP）行肩关节镜检查期间发生脑饱和度降低事件（CDE）的发生率。
方法
共收集了 124 例行择期肩关节镜检查的患者数据，其中 61 例在 BCP 位，63 例在 LDP 位。所有患者的麻醉管理均标准化。使用近红外光谱仪定量测定局部脑组织氧饱和度（Scto(2)）。在患者定位前和手术过程中每 3 分钟测量一次基础心率、平均动脉血压、动脉血氧饱和度和 Scto(2)。Scto(2)值低于临界阈值（与基线相比下降>20%或绝对值<55%持续>15 秒）定义为 CDE，并采用预定方案进行治疗。记录 CDE 的数量和用于治疗低 Scto(2)值的干预类型。还评估了术中 CDE 与术后恢复受损之间的关系。
结果
BCP 和 LDP 组的麻醉管理相似，除了 LDP 组中使用了更多的肌间沟阻滞。两组术中血流动力学变量无差异。整个手术过程中，BCP 组的 Scto(2)值较低（P < 0.0001）。BCP 组的 CDE 发生率较高（80.3%比 LDP 组的 0%），每个患者的 CDE 中位数也较高（4，范围 0-38 比 LDP 组的 0，范围 0-0），所有 P < 0.0001）。在所有未行肌间沟阻滞的研究患者中，与无 CDE 的患者相比，术中发生 CDE 的患者恶心发生率（50.0%比 6.7%，P = 0.0001）和呕吐发生率（27.3%比 3.3%，P = 0.011）更高。
结论
与 LDP 相比，BCP 下行肩部手术与脑氧合显著降低有关。
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