Hemodynamics and cerebral oxygen metabolism in patients undergoing non-intubated video-assisted thoracic surgery
10.12007/j.issn.0258-4646.2024.12.009
- VernacularTitle:非插管麻醉的胸腔镜手术中对患者血流动力学及脑氧代谢的变化
- Author:
Lingfei WANG
1
;
Yuening ZHAN
1
;
Dan WANG
1
;
Yanmei ZHANG
1
;
Zeqing HUANG
1
Author Information
1. 中国医科大学肿瘤医院,辽宁省肿瘤医院麻醉科,沈阳 110042
- Publication Type:Journal Article
- Keywords:
non-intubated video-assisted thoracic surgery;
hemodynamics;
cerebral oxygen metabolism
- From:
Journal of China Medical University
2024;53(12):1111-1117
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the effects of preserved voluntary breathing non-intubated video-assisted thoracic surgery (NIVATS) on hemodynamics and cerebral oxygen metabolism in patients. Methods From May 2020 to September 2021,120 patients undergoing elective thoracoscopic radical resection of lung cancer or lung wedge resection,aged 33-67 years,American Society of Anesthesiologists grades Ⅰ-Ⅱ,were selected and randomly divided into the NIVATS group (with laryngeal mask ventilation for preserving spontaneous respiration) and the IVATS group (with intraoperative one-lung ventilation with double-lumen tracheal intubation),with 60 patients in each group. The cardiac output (CO),stroke volume variation (SVV),heart rate variation (HRV),oxygen saturation (SpO2),arterial partial pressure of oxygen (PaO2),and partial pressure of carbon dioxide (PaCO2) were recorded,and the jugular venous oxygen content (CjvO2) was monitored to calculate the arterio-jugular venous oxygen content difference (Da-jvO2) and cerebral oxygen extraction ratio (CERO2) at five time points. These points were before anesthesia induction (T0),immediately after intubation (laryngeal mask,T1),30 min (T2) and 60 min (T3) after the start of surgery (one-lung ventilation),and 15 min (T4) after extubation (laryngeal mask). Results No statistically sig-nificant differences were observed in the scores for satisfaction with anesthesia and the surgical field,duration of anesthesia,or duration of surgery between the two groups (P>0.05 for all). In addition,no statistically significant differences were observed in intraoperative blood loss,intraoperative colloid fluid usage,crystalloid fluid usage,and the number of lymph nodes dissected (P>0.05 for all). Compared with the IVATS group,CO was significantly higher and SVV was significantly lower (P<0.05) at T1,T2,and T3 in the NIVATS group. The diffe-rence in HRV between the two groups at each time point was significant (P<0.05). The PaO2 and CjvO2 in the two groups at T2 and T3 were significantly different (P<0.05). Da-jvO2 and CERO2 were significantly higher in the NIVATS group than in the IVATS group at T2,T3,and T4 (all P<0.05). In addition,the PaCO2 was significantly higher in the NIVATS group than in the IVATS group at T1,T2,and T3 (all P<0.05). Conclusion Compared with one-lung ventilation during double-lumen endotracheal intubation,the intraoperative hemo-dynamic indicators (CO,SVV,and HRV) of patients under NIVATS who maintained spontaneous breathing tended to be more stable,whereas the cerebral oxygen metabolism indicators (Da-jvO2 and CERO2) remained at a higher level. This may exhibit a positive effect on the recovery of cognitive function after thoracoscopic surgery.
