Application of cerebral oxygen saturation monitoring in perioperative period of pheochromocytoma

doi:10.3877/cma.j.issn.1674-3253.2020.05.006

Abstract

Abstract:

Objective

To investigate the significance of cerebral oxygen saturation monitoring in retrolaparoscopic pheochromocytoma resection.

Methods

The clinical data of a total of 55 patients undergoing retroperitoneal laparoscopic pheochromocytoma resection from March 2018 to September 2019 were retrospectively collected. They were divided into experimental group (group A) of 34 patients and control group (group B) of 21 patients. rScO₂ was monitored during operation in group A; rScO₂ was not monitored in group B. central venous pressure (CVP) and rScO₂ in group A were respectively recorded at T₁ (before tumor resection), T₂ (in tumor resection), T₃ (after tumor resection), T₄ (5 min before pneumoperitoneum resection). The immediate blood gas PH, PaCO₂, Hb, Lac, blood glucose and other data of T₁-T₄ were detected and recorded. Montreal Cognitive Assessment (MoCA) was respectively performed at 1 day before surgery and 7 days after surgery. S-100β protein was respectively detected after entering the operating room and 3 days after operation.

Results

Compared with T_{1, 2, 4}, CVP decreased significantly at T₃ in the two groups (P<0.05). Compared with T₁ and T₄, rScO₂ increased significantly at T₂ and decreased significantly at T₃ in group A (P<0.05). Compared with T_{1, 2, 4}, Lac increased significantly at T₃ (P<0.05). PaCO₂, PaO₂, PH and Hb were not significantly different between the two groups (P>0.05) at T₁-T₄. The level of s-100β protein in group A was lower than that in group B at 3 days after operation (P<0.05). Compared with that immediately after entering the operating room, the level of S-100β protein increased significantly at 3 days after operation in the two groups (P<0.05). Compared with 1 day before operation, MoCA significantly decreased on 7 days after operation in two groups (P<0.05). The incidence of POCD in group A was lower than that in group B (P<0.05).

Conclusion

Monitoring rScO₂ and dealing with cerebral oxygen supply-demand imbalance in retrolaparoscopic pheochromocytoma resection can protect the brain and reduce the incidence of POCD.

Key words: Pheochromocytoma, Regional cerebral oxygen saturation, Cerebral protection, Cognitive dysfunction

Renrui Liang, Xiaoyuan Cui, Chunyan Wang, Zhelu Fan. Application of cerebral oxygen saturation monitoring in perioperative period of pheochromocytoma[J]. Chinese Journal of Endourology(Electronic Edition), 2020, 14(05): 343-347.

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分组	例数	ASA分级（例，Ⅱ/Ⅲ）	年龄（岁，±s）	BMI（Kg/m²，±s）	手术时长（min，±s）	受教育年限（年，±s）
A组	34	23/11	49±11	21.11±1.24	87±21	8.77±3.12
B组	21	14/7	50±11	20.98±1.09	90±24	8.84±3.32

分组	例数	ASA分级（例，Ⅱ/Ⅲ）	年龄（岁，±s）	BMI（Kg/m²，±s）	手术时长（min，±s）	受教育年限（年，±s）
A组	34	23/11	49±11	21.11±1.24	87±21	8.77±3.12
B组	21	14/7	50±11	20.98±1.09	90±24	8.84±3.32

项目	组别	T₁	T₂	T₃	T₄	P值
CVP（cmH₂O）	A组	7.12±3.31	8.95±3.29	4.64±2.95^*	6.74±3.11	P=0.001
CVP（cmH₂O）	B组	7.08±3.27	9.01±3.44	4.72±3.10^*	6.62±3.24	P=0.001
rScO₂ %	A组	68.33±3.885	71.21±3.16^*	59.15±2.61^*	64.67±3.36	P=0.004
血糖（mmol/L）	A组	97±1.21	7.15±2.03	9.55±2.17^*	8.57±1.89	P=0.007
血糖（mmol/L）	B组	6.01±1.18	6.99±1.91	9.27±1.98^*	8.44±1.73	P=0.010
pH	A组	7.39±0.04	7.36±0.03	7.35±0.03 ^*	7.38±0.05	P>0.05
pH	B组	7.37±0.05	7.38±0.04	7.36±0.04^*	7.37±0.03	P>0.05
Hb （g/L）	A组	13.34±1.65	13.38±1.54	13.14±1.35^*	12.92±1.75	P>0.05
Hb （g/L）	B组	13.42±1.58	13.39±1.49	13.17±1.55^*	12.88±1.68	P>0.05
Lac（mmol/L）	A组	0.63±0.10	1.27±0.17	1.65±0.18^*	1.47±0.12	P=0.001
Lac（mmol/L）	B组	0.57±0.12	1.23±0.15	1.73±0.16^*	1.51±0.14	P=0.001
PaCO₂（mmHg）	A组	36.25±2.84	37.18±3.42	37.72±2.88^*	36.53±2.72	P>0.05
PaCO₂（mmHg）	B组	36.44±2.77	36.91±3.14	37.36±2.67^*	36.67±2.82	P>0.05
PaO₂（mmHg）	A组	399±64.27	402±67.43	389±69.16	395±73.47	P>0.05
PaO₂（mmHg）	B组	411±70.31	398±69.92	386±68.45	404±71.64	P>0.05

项目	组别	T₁	T₂	T₃	T₄	P值
CVP（cmH₂O）	A组	7.12±3.31	8.95±3.29	4.64±2.95^*	6.74±3.11	P=0.001
CVP（cmH₂O）	B组	7.08±3.27	9.01±3.44	4.72±3.10^*	6.62±3.24	P=0.001
rScO₂ %	A组	68.33±3.885	71.21±3.16^*	59.15±2.61^*	64.67±3.36	P=0.004
血糖（mmol/L）	A组	97±1.21	7.15±2.03	9.55±2.17^*	8.57±1.89	P=0.007
血糖（mmol/L）	B组	6.01±1.18	6.99±1.91	9.27±1.98^*	8.44±1.73	P=0.010
pH	A组	7.39±0.04	7.36±0.03	7.35±0.03 ^*	7.38±0.05	P>0.05
pH	B组	7.37±0.05	7.38±0.04	7.36±0.04^*	7.37±0.03	P>0.05
Hb （g/L）	A组	13.34±1.65	13.38±1.54	13.14±1.35^*	12.92±1.75	P>0.05
Hb （g/L）	B组	13.42±1.58	13.39±1.49	13.17±1.55^*	12.88±1.68	P>0.05
Lac（mmol/L）	A组	0.63±0.10	1.27±0.17	1.65±0.18^*	1.47±0.12	P=0.001
Lac（mmol/L）	B组	0.57±0.12	1.23±0.15	1.73±0.16^*	1.51±0.14	P=0.001
PaCO₂（mmHg）	A组	36.25±2.84	37.18±3.42	37.72±2.88^*	36.53±2.72	P>0.05
PaCO₂（mmHg）	B组	36.44±2.77	36.91±3.14	37.36±2.67^*	36.67±2.82	P>0.05
PaO₂（mmHg）	A组	399±64.27	402±67.43	389±69.16	395±73.47	P>0.05
PaO₂（mmHg）	B组	411±70.31	398±69.92	386±68.45	404±71.64	P>0.05

时间	组别	S-100β蛋白（pg/L）	时间	组别	MoCA
时间	组别	S-100β蛋白（pg/L）	时间	组别	分	<27分(例数)
入室即刻	A组	46.21±6.32	术前1 d	A组	28.32±0.94 ^#	1
入室即刻	B组	48.19±6.13	术前1 d	B组	28.11±1.00^#	2
术后3 d	A组	116.35±9.63^#	术后7 d	A组	27.29±1.22^#	7
术后3 d	B组	105.44±8.71^#	术后7 d	B组	26.44±0.98^#	10

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