Department of Anesthesiology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China.
Department of Hepatological Surgery, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China.
BMC Anesthesiol. 2023 Jul 31;23(1):257. doi: 10.1186/s12871-023-02220-y.
Laparoscopic hepatectomy under low central venous pressure (LCVP) is associated with intraoperative organ hypoperfusion, including cerebral hypoperfusion. We hypothesized that a ventilation strategy designed to achieve targeted mild hypercapnia (TMH) (end-tidal carbon dioxide partial pressure [PetCO] of 45 ± 5 mmHg) rather than targeted normocapnia (TN) (PetCO of 30 ± 5 mmHg) would increase regional cerebral oxygen saturation (rSO) during laparoscopic hepatectomy under LCVP.
Eighty patients undergoing laparoscopic hepatectomy under LCVP were randomly divided into the TMH group (n = 40) and the TN group (n = 40). Mechanical ventilation was adjusted to maintain the PetCO within the relevant range. Cerebral oxygenation was monitored continuously using the FORE-SIGHT system before anesthetic induction until the patient left the operating room. Patient and surgical characteristics, rSO, intraoperative hemodynamic parameters (CVP, mean artery blood pressure [MAP], and heart rate), PetCO, intraoperative blood gas analysis results, and postoperative complications were recorded.
No significant differences were observed in CVP, MAP, and heart rate between the two groups during surgery. The rSO was significantly lower in the TN group on both the left and right sides during the intraoperative period (P < 0.05), while the TMH group had a stable rSO. In the TN group, the mean rSO decreased most during liver parenchymal transection when compared with the baseline value (P < 0.05). The mean (standard deviation) percentage change in rSO from baseline to parenchymal transection was - 7.5% (4.8%) on the left and - 7.1% (4.6%) on the right. The two groups had a similar incidence of postoperative complications (P > 0.05).
Our findings demonstrate that rSO is better maintained during laparoscopic hepatectomy under LCVP when patients are ventilated to a PetCO of 45 ± 5 mmHg (TMH) than a PetCO of 30 ± 5 mmHg (TN).
ChiCTR2100051130(14/9/2021).
在低中心静脉压（LCVP）下进行腹腔镜肝切除术会导致术中器官灌注不足，包括脑灌注不足。我们假设，与目标正常碳酸血症（TN）（呼气末二氧化碳分压[PetCO]为 30 ± 5 mmHg）相比，设计用于实现目标轻度高碳酸血症（TMH）（PetCO 为 45 ± 5 mmHg）的通气策略将增加 LCVP 下腹腔镜肝切除术中的局部脑氧饱和度（rSO）。
80 例行 LCVP 下腹腔镜肝切除术的患者被随机分为 TMH 组（n=40）和 TN 组（n=40）。调整机械通气以维持相关范围内的 PetCO。在麻醉诱导前和患者离开手术室前，使用 FORE-SIGHT 系统连续监测脑氧合。记录患者和手术特征、rSO、术中血流动力学参数（CVP、平均动脉血压[MAP]和心率）、PetCO、术中血气分析结果和术后并发症。
手术过程中两组间 CVP、MAP 和心率无显著差异。术中 TN 组左右两侧 rSO 均明显低于基础值（P<0.05），而 TMH 组 rSO 稳定。与基础值相比，TN 组在肝实质切开时 rSO 平均降低最多（P<0.05）。rSO 从基线到实质切开的平均（标准差）百分比变化为左侧-7.5%（4.8%），右侧-7.1%（4.6%）。两组术后并发症发生率相似（P>0.05）。
与 PetCO 为 30 ± 5 mmHg（TN）相比，在 LCVP 下进行腹腔镜肝切除术时，将患者通气至 PetCO 为 45 ± 5 mmHg（TMH）时，rSO 维持得更好。
ChiCTR2100051130（2021 年 9 月 14 日）。
