脑氧饱和度监测下磷酸肌酸钠对腰椎手术患者术后早期恢复质量的影响

Effects of creatine phosphate sodium on early recovery quality in patients undergoing lumbar surgery under cerebral oxygen saturation monitoring

中文关键词: 脑氧饱和度监测  腰椎手术  磷酸肌酸钠  恢复质量

中文摘要:

      
目的 探讨脑氧饱和度（rSO₂）监测下磷酸肌酸钠对腰椎手术患者术后早期恢复质量的影响。
方法 选择2021年10月至2022年1月全麻下拟行腰椎体融合术的患者118例，男51例，女67例，年龄18～64岁，BMI<30 kg/m²，ASA Ⅱ或Ⅲ级。将患者随机分为两组：磷酸肌酸钠组（P组）和对照组（C组），每组59例。术中监测rSO₂并维持下降幅度不超过基线值的20%。手术开始后30 min内，P组静脉滴注磷酸肌酸钠1.0 g（溶于生理盐水100 ml）；C组静脉滴注生理盐水100 ml。于术前1 d、术后1、3 d采用恢复质量量表（QoR-15）评估患者恢复质量。记录术中rSO₂降低次数及处理措施、术中麻醉药物用量、手术时间、麻醉时间、出血量、输液量、拔管时间、麻醉复苏室（PACU）停留时间、术后首次肛门排气时间、术后首次下床活动时间和术后住院时间。记录术后低血压、便秘、术后恶心呕吐（PONV）、谵妄和心律失常发生情况。
结果 与术前1 d比较，术后1、3 d两组QoR-15评分明显降低（P<0.05）。与C组比较，P组术后1、3 d QoR-15评分明显升高，术中rSO₂降低发生率明显降低，拔管时间、PACU停留时间、术后首次肛门排气时间和术后住院时间明显缩短，术后便秘、PONV和谵妄发生率明显降低（P<0.05）。
结论 脑氧饱和度监测下磷酸肌酸钠可以改善脊柱腰椎手术中脑氧饱和度，维持脑氧供需稳定，缩短患者术后住院时间，促进患者早期康复。

英文摘要:

      
Objective To investigate the effect of creatine phosphate sodium on early recovery quality in patients undergoing lumbar surgery under cerebral oxygen saturation (rSO₂) monitoring.
Methods A total of 118 patients from Octomber 2021 to January 2022, 51 males and 67 females, aged 18-64 years, BMI < 30 kg/m², ASA physical status Ⅱ or Ⅲ, underwent lumbar fusion surgery with general anesthesia were randomly divided into two groups: creatine phosphate sodium group (group P) and control group (group C), 59 patients in each group. Intraoperatively monitor rSO₂ and maintain a decrease of no more than 20% of the baseline value. Within 30 minutes after operation,creatine phosphatesodium 1.0 g (dissolved in normal saline 100 ml) was intravenously injected in group P, and group C received the same volume of normal saline intravenously. The QoR-15 scale was used to assess the recovery quality of patients respectively 1 day before operation, 1 day and 3 days after operation. The number of intraoperative rSO₂ reductions and management measures, dosages of intraoperative anesthetic, the duration of anesthesia and surgery, blood loss, infusion volume, time of extubation of tracheal tube, length of post-anesthesia care unit (PACU) stay, the time of first postoperative anal exhaust, the time of first postoperative out of bed, and postoperative hospital stay were recorded. The incidence of postoperative hypotension, constipation, postoperative nausea and vomiting (PONV), delirium and arrhythmia were recorded.
Results Compared with 1 day before operation, QoR-15 scores were significantly decreased in the two groups 1 day and 3 days after operation (P < 0.05). Compared with group C, QoR-15 scores were significantly increased 1 day and 3 days after operation, the incidence of rSO₂ reduction during operation was significantly reduced,the time of extubation of tracheal tube, length of PACU stay, the time of first postoperative anal exhaust, and postoperative hospital stay were significantly shorterned, the incidence of postoperative constipation, PONV, and delirium were significantly decreased in group P (P < 0.05).
Conclusion Sodium creatine phosphate under the monitoring of rSO₂ can improve rSO₂ during spinal and lumbar surgery, maintain the stability of cerebral oxygen supply and demand, shorten the length of postoperative hospital stay, and promote the early recovery of patients.