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丙泊酚麻醉下脑氧供需平衡及脑血流自动调节范围的影响因素
Influencing factors of cerebral oxygen supply-consumption balance and cerebral autoregulation under propofol anesthesia
- 第三军医大学学报 2021年43卷第4期 页码：335-341
- 作者机构：
400038 重庆，陆军军医大学(第三军医大学)第一附属医院麻醉科
- 作者简介：
[ 鲁开智, E-mail: lukaizhi2010@163.com LU Kaizhi, E-mail:lukaizhi2010@163.com
- 基金信息：国家自然科学基金青年科学基金(81601569)
DOI：10.16016/j.1000-5404.202009115
中图分类号： R331.37;R614.2;R741.04收稿：2020-09-14，
修回：2020-11-12，
纸质出版：2021-02-28
- 稿件说明：
移动端阅览
辜梦月, 陈妍, 杨纯勇, 等. 丙泊酚麻醉下脑氧供需平衡及脑血流自动调节范围的影响因素[J]. 第三军医大学学报, 2021,43(4):335-341.
Mengyue GU, Yan CHEN, Chunyong YANG, et al. Influencing factors of cerebral oxygen supply-consumption balance and cerebral autoregulation under propofol anesthesia[J]. Journal of Third Military Medical University, 2021, 43(4): 335-341.
辜梦月, 陈妍, 杨纯勇, 等. 丙泊酚麻醉下脑氧供需平衡及脑血流自动调节范围的影响因素[J]. 第三军医大学学报, 2021,43(4):335-341. DOI： 10.16016/j.1000-5404.202009115.
Mengyue GU, Yan CHEN, Chunyong YANG, et al. Influencing factors of cerebral oxygen supply-consumption balance and cerebral autoregulation under propofol anesthesia[J]. Journal of Third Military Medical University, 2021, 43(4): 335-341. DOI： 10.16016/j.1000-5404.202009115.
摘要
目的
2
探讨丙泊酚麻醉下脑氧供需平衡和脑血流自动调节(cerebral autoregulation
CA)范围的影响因素。
方法
2
纳入我院肝胆外科2019年8月至2020年1月在丙泊酚麻醉下行开腹手术的患者共66例。收集患者的一般资料。实时采集患者从入手术室至手术结束期间的局部脑氧饱和度(regional cerebral oxygen saturation，rSO
2
)、局部脑组织血红蛋白浓度指数(tissue hemoglobin concentration index，THI)来评价脑氧供需平衡，并采集平均动脉压(mean arterial pressure，MAP)、心脏指数及动脉血气分析指标。然后分别通过计算rSO
2
与MAP的pearson相关系数得到脑血氧测定指数(cerebral oximetry index，COx)、计算THI与MAP的pearson相关系数得到脑总血红蛋白反应指数(total hemoglobin reactivity index，THx)。根据COx和THx设立每位患者CA范围的上限和下限。通过单因素分析和多因素线性回归分析的方法，对患者的一般资料、术中监测数据和血气分析指标进行分析，分别筛选出rSO
2
、THI以及由COx和THx所界定的CA范围上下限的影响因素。
结果
2
经单因素分析剔除混杂因素后，多因素线性回归分析显示rSO
2
的影响因素包括手术时长、总血红蛋白浓度(
P
<
0.05)；THI的影响因素包括年龄(
P
<
0.05)；通过COx获得的CA范围上下限的影响因素包括高血压病史、术中MAP、PaO
2
(
P
<
0.05)；通过THx获得的CA范围上下限的影响因素包括高血压病史、术中MAP(
P
<
0.05)。
结论
2
在丙泊酚麻醉下，脑氧供需平衡的影响因素有年龄、手术时长、总血红蛋白浓度；脑血流自动调节范围的影响因素有高血压病史、术中MAP、PaO
2
。
Abstract
Objective
2
To investigate the influencing factors of cerebral oxygen supply-consumption balance and cerebral autoregulation (CA) under propofol anesthesia.
Methods
2
A total of 66 patients undergoing open abdominal s
urgery with propofol anesthesia in our hospital from August 2019 to January 2020 were prospectively recruited in this study. Their general information was collected. Regional cerebral oxygen saturation (rSO
2
)
cerebral tissue hemoglobin concentration index (THI)
mean arterial pressure (MAP)
arterial blood gas indexes
and cardiac index (CI) were collected real-timely from entering the operating room to the end of the operation. Then Pearson correlation coefficients of rSO
2
and MAP were calculated for cerebral oximetry index (COx)
and the coefficients of THI and MAP were obtained for cerebral total hemoglobin reactivity index (THx) in order to find out the upper and lower limits of CA range. Univariate analysis and multivariate linear regression analysis were used to analyze the general data
intraoperative monitoring data and blood gas indexes to screen out the influencing factors for rSO
2
THI
and the upper and lower limits of the CA range defined by COx and THx.
Results
2
After elimination of confounding factors by univariate analysis
multivariate linear regression analysis showed that the influencing factors of rSO
2
included operation time and total hemoglobin concentration (
P
<
0.05)
that of THI was age (
P
<
0.05)
and those for the upper and lower limits of CA obtained by COx included the history of hypertension (
P
<
0.05)
intraoperative MAP (
P
<
0.05)
and PaO
2
(
P
<
0.05). The influencing factors of the upper and lower limits of CA obtained by THx included the history of hypertension (
P
<
0.05) and intraoperative MAP (
P
<
0.05).
Conclusion
2
Age
total hemoglobin concentration
and operation duration are the influencing factors of the balance of cerebral oxygen supply and demand in the patients under propofol anesthesia
and the history of hypertension
intraoperati
ve MAP
PaO
2
are the influencing factors of cerebral blood flow autoregulation.
关键词
Keywords
references
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