Woo Jae Hee, Kim Youn Jin, Jeong Ji-Sun, Chae Ji Seon, Lee Young Rong, Chon Jin Young
Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Korean J Anesthesiol. 2018 Apr;71(2):127-134. doi: 10.4097/kjae.2018.71.2.127. Epub 2018 Apr 2.
The beach-chair position (BCP) results in decreases in venous return, cardiac output, and cerebral perfusion pressure. In this randomized, prospective study, we investigated whether applying thigh-high compression stockings affected the maintenance of regional cerebral tissue oxygen saturation (rSO) in the BCP.
Patients undergoing orthopedic surgery in the BCP under general anesthesia were included and assigned randomly to the control or the compression stocking group. Appropriately sized thigh-high compression stockings were applied to the patients in the stockings group. All patients were tilted, up to 45°, throughout the operation. Non-invasive blood pressure, invasive arterial blood pressure zeroed at the external auditory meatus, and rSO were recorded.
Data were analyzed from 19 patients per group. In the BCP, the values of rSO and blood pressure decreased significantly compared with those at baseline, with no significant difference between the groups. The incidences of cerebral desaturation events (CDEs) were similar between the groups; however, that of hypotension was significantly lower in the compression stocking group. During 36 CDEs, the levels of rSO and blood pressure decreased significantly compared with those at baseline in both groups. No significant correlation was found between rSO and blood pressure.
Thigh-high compression stockings reduced the incidence of hypotension but not that of CDEs. Our results suggest that other factors, beyond hypotension itself, contribute to CDEs and in other words, efforts just to reduce the incidence of hypotension may not mainly contribute to a reduction of CDEs occurrence in the BCP under general anesthesia.
沙滩椅位（BCP）会导致静脉回流、心输出量和脑灌注压降低。在这项随机、前瞻性研究中，我们调查了应用大腿高位加压弹力袜是否会影响BCP时局部脑组织氧饱和度（rSO）的维持。
纳入在全身麻醉下采用BCP进行骨科手术的患者，并随机分为对照组或加压弹力袜组。给弹力袜组患者应用尺寸合适的大腿高位加压弹力袜。所有患者在整个手术过程中均倾斜至45°。记录无创血压、在外耳道水平归零的有创动脉血压和rSO。
每组分析了19例患者的数据。在BCP状态下，rSO和血压值与基线相比显著降低，两组之间无显著差异。两组之间脑氧饱和度降低事件（CDEs）的发生率相似；然而，加压弹力袜组低血压的发生率显著更低。在36次CDEs期间，两组的rSO和血压水平与基线相比均显著降低。未发现rSO与血压之间存在显著相关性。
大腿高位加压弹力袜降低了低血压的发生率，但未降低CDEs的发生率。我们的结果表明，除低血压本身外，其他因素也会导致CDEs，换句话说，仅致力于降低低血压发生率可能无法主要降低全身麻醉下BCP时CDEs的发生。
