朱丹艳 周斌 彭文勇 屠文龙

[摘要] 目的 探讨允许性高碳酸血症对沙滩椅位下（BCP）肩关节镜手术患者的影响。 方法 纳入我院于2018年6月至2019年12月间收治的124例择期拟行沙滩椅位肩关节镜手术患者作为研究样本，采用随机数字表法将其划分为观察组（允许性高碳酸血症）与对照组各62例，两组麻醉方法相同，取沙滩椅体位后，对照组维持动脉血二氧化碳分压（PaCO2）35～45 mmHg，观察组调整通气频率使PaCO2维持45～55 mmHg;观察两组于诱导后BCP前、BCP后即刻、5、10、15、20、25、30、35、40、45、50 min和術毕（T0～12）时的脑氧饱和度（rSO2）、脑去氧饱和度事件（CDE）出现率、麻黄碱和去氧肾上腺素使用百分比、拔除气管插管时间、PACU滞留时间、恶心发生率、呕吐发生率。 结果 对照组在T1～12时间点rSO2比T0降低，观察组rSO2在T2～6时间点比T0下降（P<0.05）;观察组T1～12时间点rSO2比对照组更高，差异有统计学意义（P<0.05）。观察组脑去氧饱和度事件（CDE）发生率为4.84%，低于对照组的16.13%，差异有统计学意义（P<0.05）;观察组和对照组麻黄碱使用率为64.52% vs. 69.35%、去氧肾上腺素使用率为70.97% vs. 66.13%、拔除气管导管时间为（30.12±9.25）min vs. （31.02±9.85）min、手术麻醉后监护室（PACU）滞留时间为（54.92±17.29）min vs. （55.07±18.02）min、恶心发生率为8.06% vs. 12.90%、呕吐发生率为1.61% vs. 0，差异无统计学意义（P>0.05）。结论 允许性高碳酸血症可改善BCP下肩关节镜手术患者的脑氧供需平衡。

[关键词] 允许性高碳酸血症;肩关节镜手术;沙滩椅位;脑氧饱和度

[中图分类号] R68          [文献标识码] B          [文章编号] 1673-9701（2021）31-0138-04

[Abstract] Objective To explore the effect of permissive hypercapnia on patients undergoing shoulder arthroscopic surgery under the beach chair position（BCP）. Methods A total of 124 patients who were admitted to our hospital from June 2018 to December 2019 and were scheduled to undergo shoulder arthroscopic surgery at beach chair position were included as the study samples. The patients were divided into the observation group（permissive hypercapnia） and the control group， with 62 patients in each group by the random number table method. The anesthesia methods of both groups were the same. After taking the beach chair position， in the control group， the arterial blood partial pressure of carbon dioxide （PaCO2） was maintained at 35-45 mmHg， whereas in the observation group， the PaCO2 was maintained at 45-55 mmHg by adjusting the ventilation frequency. The cerebral oxygen saturation （rSO2）， cerebral deoxygenation event （CDE） incidences， the use percentages of ephedrine and norepinephrine， the time of tracheal intubation removal， the retention time of PACU， the incidences of nausea， and the incidences of vomiting in both groups were observed before and immediately after BCP induction， at 5， 10， 15， 20， 25， 30， 35， 40， 45， 50 min after BCP induction， and after surgery （T0-12）. Results In the control group， the rSO2 at time points T1-12 was decreased compared with that at T0， and in the observation group， rSO2 at time points T2-6 was decreased compared with that at T0， the difference was statistically significant（P<0.05）. rSO2 in the observation group was higher than that in the control group at time points T1-12， the difference was statistically significant（P<0.05）. The cerebral desaturation events （CDE） rate in the observation group was 4.84%， which was lower than 16.13% in the control group ，the difference was statistically significant（P<0.05）. In the observation group and the control group， the utilization rates of ephedrine were 64.52% vs. 69.35%; the utilization rates of norepinephrine were 70.97% vs. 66.13%; the time of tracheal catheter removal was（30.12±9.25） min vs. （31.02±9.85） min; postanesthesia care unit （PACU） durations of stay were （54.92±17.29） min vs. （55.07±18.02） min; the incidences of nausea were 8.06% vs. 12.90%; the incidences of vomiting were 1.61% vs. 0， respectively， with no statistically significant differences （P>0.05）. Conclusion Permissive hypercapnia can improve the balance of cerebral oxygen supply and demand in BCP patients undergoing shoulder arthroscopic surgery.

[Key words] Permissive hypercapnia; Shoulder arthroscopic surgery; Beach chair position; Cerebral oxygen saturation

近年来随着临床外科手术技术的不断发展进步，肩关节镜手术在临床应用范围也越来越广，手术适应证包括肩关节脱位、肩袖断裂、肱二头肌断裂、骨关节炎、肩化脓性关节炎等[1]。……