Cerebral Oximetry Monitoring During Sinus Endoscopy
Cerebral Oximetry Monitoring During Sinus Endoscopy
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DOI：
10.1002/lary.25027
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发表时间：
2015-04-01
期刊：
影响因子：
2.6
通讯作者：
Weiner, Menachem M.
中科院分区：
文献类型：
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作者：
Heller, Joshua A.;DeMaria, Samuel, Jr.;Weiner, Menachem M.
目的/假设故意低血压、反向特伦德伦伯卧位和过度通气是功能性内窥镜鼻窦手术期间用来减少手术出血的技术。这些方法可能会使患者容易发生脑缺血。脑血氧定量法尚未在耳鼻喉科手术中得到广泛研究。我们的研究试图解决脑血氧测定法在 FESS 人群中是否可行的问题，并评估所提供的数据是否可用于评估脑灌注。研究设计前瞻性、盲法、观察性试验。方法我们设计了一项前瞻性、盲法、观察性试验，对象是接受功能性内窥镜鼻窦手术的患者，使用脑血氧法监测。收集的数据包括平均动脉血压 (MAP)、呼气末二氧化碳 (EtCO2)、脑饱和度 (SctO(2))、麻醉后监护室 (PACU) 住院时间以及术后恶心和呕吐 (PONV) 发生率。 结果 31 名受试者纳入该研究。单变量分析显示，同时 EtCO2 值和 SctO(2) 之间的互相关性为 0.43（95% CI：0.27 至 0.59），当前 EtCO2 与 5 分钟后的 SctO(2) 之间的互相关性为 0.46（95% CI：0.33 至 0.59）。 MAP 与 SctO(2) 没有显着的互相关性。任何时候 SctO(2) 低于 60% 的患者 PACU 住院时间中位数（四分位距 [IQR]）为 167（IQR，95-386）分钟。脑饱和度在任何时间都不低于 60% 的患者 PACU 住院时间中位数为 103 分钟（IQR，76-155）分钟。该差异未达到统计学显着性（P=.257）。 PONV 患者 SctO(2) 最大下降中位数 (IQR) 为 11.2%（IQR，8.2%-13.1%），无 PONV 患者为 7.1%（IQR，5.1%-9.8%）（P=.126）。 结论 在功能性内窥镜鼻窦手术期间进行脑血氧饱和度监测是可行的。这项研究证明了 EtCO2 和 SctO(2) 之间存在互相关性，但 MAP 和 SctO(2) 之间没有互相关性。 PACU 住院时间较长，PONV 发生率较高，但未达到统计学显着性。Level of Evidence2b Laryngoscopy，125：E127-E131，2015
Objectives/HypothesisDeliberate hypotension, reverse Trendelenburg position, and hyperventilation are techniques utilized during functional endoscopic sinus surgery to attempt to reduce surgical bleeding. These methods may predispose patients to cerebral ischemia. Cerebral oximetry has not been investigated extensively within otolaryngologic surgery. Our study sought to address the question of whether cerebral oximetry is feasible in the FESS population and evaluate whether the data provided may be useful in the assessment of cerebral perfusion.Study DesignProspective, blinded, observational trial.MethodsWe designed a prospective, blinded, observational trial of patients undergoing functional endoscopic sinus surgery using cerebral oximetry monitoring. Collected data included mean arterial blood pressure (MAP), end-tidal carbon dioxide (EtCO2), cerebral saturation (SctO(2)), postanesthesia care unit (PACU) length of stay, and incidence of postoperative nausea and vomiting (PONV).ResultsThirty-one subjects were enrolled into the study. Univariate analyses showed cross-correlation between concurrent EtCO2 values and SctO(2) of 0.43 (95% CI: 0.27 to 0.59) and between present EtCO2 and the SctO(2) 5 minutes later of 0.46 (95% CI: 0.33 to 0.59). MAP was not significantly cross-correlated with SctO(2). Patients who had an SctO(2) below 60% at any time had a median (interquartile range [IQR]) PACU length of stay of 167 (IQR, 95-386) minutes. Patients whose cerebral saturation did not fall below 60% at any time had a median PACU length of stay of 103 (IQR, 76-155) minutes. This difference did not reach statistical significance (P=.257). The median (IQR) maximum decline in SctO(2) for patients with PONV was 11.2% (IQR, 8.2%-13.1%) and for patients without PONV was 7.1% (IQR, 5.1%-9.8%) (P=.126).ConclusionsCerebral oximetry monitoring was feasible during functional endoscopic sinus surgery. This study demonstrated a cross-correlation between EtCO2 and SctO(2), but not MAP and SctO(2). A longer PACU length of stay and higher rate of PONV were seen but did not reach statistical significance.Level of Evidence2b Laryngoscope, 125:E127-E131, 2015