Relevance Study Between Hypocerebral Oxygen Saturation And Postoperative Complications During Lung Lavage With One-Lung Ventilation

Objective By intraoperative monitoring of cerebral oxygen saturation in patients undergoing whole lung lavage,to compare the relationship between cerebral oxygen saturation and other intraoperative monitoring indicators,recovery time and pulmonary function changes,analyze the correlation between cerebral oxygen saturation and the postoperative prognosis of patients,early discover the balance of cerebral oxygen supply and demand and the changes of cerebral blood flow during one-lung ventilation,judge the degree of cerebral ischemia and hypoxia and the changes of brain function.Methods 58 pneumoconiosis patients undergoing whole lung lavage with one-lung ventilation under general anesthesia,with physique grades ?-? of ASA,continuous monitoring of cerebral oxygen saturation during operation,the preoperative general condition,intraoperative vital signs,BIS,pulse oxygen saturation,mean arterial pressure,heart rate,end-expiratory carbon dioxide,duration of one-lung ventilation and anesthesia were recorded,the baseline value of cerebral oxygen saturation was determined when patients were awake after pure oxygen inhalation into the room(T0),statistics out the changes of cerebral oxygen saturation during operation compared with baseline values and the duration,the arterial blood was collected for blood gas analysis after intake of pure oxygen(T0),end of one lung ventilation(T4)and extubation(T6),record the time from stopping anesthetic infusion to Ramsay sedation depth score to 2 minutes.The pulmonary complications,pulmonary function,hypoxemia and discharge time were followed up after operation.According to the intraoperative cerebral oxygen saturation,the patients with intraoperative cerebral oxygen saturation less than 20% of baseline value were classified as group B(Hypocerebral oxygen saturation group),The rest of the patients were classified as group A(Brain oxygen saturation normal group).Results There was no significant difference in general condition(age,weight,BMI index,preoperative pulmonary function)between the two groups(P>0.05),there were no significant differences in the duration of anesthesia,operation,one-lung ventilation,infusion volume,urine volume,total volume of lavage fluid and recovery volume,there was no difference between intraoperative medication and intraoperative hemodynamics.There was no significant difference in the recovery time of spontaneous breathing and extubation time between the patients with normal cerebral oxygen saturation and those with low cerebral oxygen saturation in the short term after operation(P>0.05),there was significant difference in the awakening time(the time from stopping anesthetic infusion to Ramsay sedation depth score to 2 minutes)between the two groups(P<0.05),the awakening time of patients with low brain oxygen saturation was longer than that of patients with normal brain oxygen saturation.One week after operation,the incidence of hypoxemia and pulmonary complications including pulmonary edema,atelectasis,pleural effusion and pulmonary infection in the hypoxic group was significantly higher than that in the normal group,and the hospital stay was significantly prolonged.There was a significant difference between the two groups(P < 0.05).All clinical parameters including age,one-lung ventilation time,pulse oxygen saturation,arterial partial pressure of oxygen,arterial partial pressure of carbon dioxide and mean arterial pressure were not correlated with postoperative complications.The time of exposure below 20% of baseline value and 25% of baseline value were significantly correlated with postoperative complications.Conclusions Hypocerebral Oxygen Saturation during massive lung lavage with one-lung ventilation can prolong the awakening time,increase the incidence of hypoxemia and pulmonary complications,and prolong the hospital stay.It has no significant correlation with hemodynamic parameters and respiratory physiological indexes during operation.