2020 年第 8 期 第 15 卷

不同呼气末二氧化碳分压对合并冠状动脉粥样硬化性心脏病行颈动脉内膜剥脱术患者术中局部脑氧饱和度的影响

Effect of different end-tidal carbon dioxide partial pressure on cerebral oxygenation in patients with coronary artery disease undergoing carotid endarterectomy

作者：崔博群张春雷林多茂赵丽云马骏

英文作者：Cui Boqun Zhang Chunlei Lin Duomao Zhao Liyun Ma Jun 

单位：首都医科大学附属北京安贞医院麻醉中心100029

英文单位：Anaesthesiology Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China 

关键词：颈动脉内膜剥脱术；局部脑氧饱和度；呼气末二氧化碳分压；机械通气

英文关键词：Carotidendarterectomy;Regionalcerebraloxygensaturation;Partialpressureofend-tidalcarbondioxide;Mechanicalventilation

• 摘要：

• 目的 探讨不同呼气末二氧化碳分压(PETCO2)对合并冠状动脉粥样硬化性心脏病（冠心病）行颈动脉内膜剥脱术(CEA)患者术中局部脑氧饱和度（rScO2）的影响。方法 选择2018年1—9月首都医科大学附属北京安贞医院收治的合并冠心病行CEA患者40例，按随机数字表法分为正常低通气组（L组）和正常高通气组（H组），各20例。L组气管插管后至颈动脉开放前调控潮气量和呼吸频率，以维持PETCO2在45～50 mmHg（1 mmHg=0.133 kPa），同时期H组调控潮气量和呼吸频率，以维持PETCO2在35～40 mmHg。记录入室建立监测后（T0）、手术开始后10 min（T1）、颈动脉阻断10 min后（T2）、颈动脉开放10 min后（T3）、术毕即刻（T4）各时点双侧rScO2。结果 2组各1例患者术中放置转流管，从试验中剔除。所有患者均未发生严重的脑缺血及脑过度灌注综合征以及心血管相关并发症。2组患者年龄、性别、颈动脉阻断时间、手术时间、美国麻醉医师协会分级差异均无统计学意义（均P＞0.05）。L组T1～T3时点双侧rScO2明显高于H组［术侧：（77±5）%比（73±5）%、（69±3）%比（64±2）%、（75±5）%比（69±6）%；非术侧：（78±6）%比（74±4）%、（72±5）%比（69±4）%、（75±5）%比（71±5）%］，且2组双侧rScO2在T2时点均低于T0、T1、T3、T4时点，差异均有统计学意义（均P＜0.05）。结论 合并冠心病行CEA患者颈动脉开放前维持PETCO2在45～50 mmHg者术中rScO2优于PETCO2在35～40 mmHg者。

• Objective To explore the effect of different end-expiratory carbon dioxide partial pressures (PETCO2) on regional cerebral oxygen saturation (rScO2) in patients undergoing carotid endarterectomy (CEA) complicated with coronary atherosclerotic heart disease (coronary heart disease).Methods From January to September 2018, 40 patients with coronary heart disease admitted to Beijing Anzhen Hospital, Capital Medical University were randomly divided into two groups: normal low ventilation group (group L) and normal high ventilation group (group H)，with 20 cases in each group. In group L, the tidal volume and respiratory rate were adjusted before tracheal intubation until the carotid artery was opened, so as to maintain PETCO2 at 45-50 mmHg. At the same time, the group H adjusted tidal volume and respiratory rate to maintain PETCO2 at 35-40 mmHg. The rScO2 was recorded after the establishment of monitoring (T0), 10 min after the start of operation (T1), 10 min after carotid artery occlusion (T2), 10 min after carotid artery opening (T3), and immediately after operation (T4). Results One patient in each group was placed a bypass tube, which was removed from the experiment. All patients did not have serious cerebral ischemia cerebral over perfusion syndrome and cardiovascular related complications. There were no significant differences in age, gender, carotid artery occlusion time, operation time and classification of American Society of Anesthesiologists between the two groups (P>0.05). In group L, the levels of rScO2 on both sides of T1-T3 were significantly higher than those in group H［operative side：（77±5）% vs （73±5）%,（69±3）% vs （64±2）%,（75±5）% vs （69±6）%；non operative side：（78±6）% vs （74±4）%,（72±5）% vs （69±4）%, （75±5）% vs （71±5）%］, and the rScO2 at T2 time point of the two groups was lower than that of T0, T1, T3 and T4 (all P＜0.05). Conclusions The rScO2 maintaining PETCO2 at 45-50 mmHg before carotid artery opening in patients with coronary heart disease undergoing CEA is better than PETCO2 at 35-40 mmHg.