Kadoi Yuji, Saito Shigeru, Goto Fumio, Fujita Nao
Department of Anesthesiology and Reanimatology, Gunma University School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
Anesth Analg. 2002 Jun;94(6):1395-401, table of contents. doi: 10.1097/00000539-200206000-00004.
The purpose of this study was to examine the effects of rewarming rate on internal jugular venous oxygen hemoglobin saturation (SjvO(2)) during the rewarming period, and long-term cognitive outcome in diabetic patients. We studied 30 diabetic patients scheduled for elective coronary artery bypass graft surgery. As a control, 30 age-matched nondiabetic patients were identified. The diabetic patients were randomly divided into two groups: the Slow Rewarming group (n = 15) (mean rewarming speed: 0.22 degrees +/- 0.07 degrees C/min, mean +/- SD) or the Standard Rewarming group (Standard group) (n = 15) (mean rewarming speed: 0.46 degrees +/- 0.09 degrees C/min, mean +/- SD). After the induction of anesthesia, a fiberoptic oximetry catheter was inserted into the right jugular bulb to monitor SjvO(2) continuously. Hemodynamic variables and arterial and jugular venous blood gases were measured at nine time points. All patients underwent a battery of neurologic and neuropsychologic tests on the day before the operation and at 4 mo after surgery. The SjvO(2) values in the Standard group were decreased during the rewarming period compared with at the induction of anesthesia (P < 0.05). There was a significant difference in the SjvO(2) value in the Control group between standard rewarming and slow rewarming during rewarming periods (Standard Control group: 51% +/- 8%, Slow Control groups: 58% +/- 5%) (P < 0.05). However, there was no difference in the SjvO(2) value in diabetic patients between standard rewarming and slow rewarming during the rewarming period. The rewarming rates (odds ratio: 0.8; 95% confidence interval: 0.5-1.3; P = 0.6) had no correlation with cognitive impairment at 4 mo after the surgery. Diabetes (odds ratio: 1.6; 95% confidence interval: 0.9-2.6; P = 0.04) was a factor in relation to cognitive impairment at 4 mo after the surgery. We concluded that a slow rewarming rate had no effects on the reduction in SjvO(2) value and long-term cognitive outcome in diabetic patients.
We examined the effects of rewarming rate on internal jugular venous oxygen hemoglobin saturation in diabetic and nondiabetic patients during the rewarming period and long-term cognitive outcome. Slow rewarming could not prevent the frequency of the reduction in internal jugular venous oxygen hemoglobin saturation and adverse cognitive outcome in diabetic patients.
本研究旨在探讨复温速率对糖尿病患者复温期颈内静脉血氧血红蛋白饱和度（SjvO₂）及长期认知结局的影响。我们研究了30例计划行择期冠状动脉搭桥手术的糖尿病患者。作为对照，选取了30例年龄匹配的非糖尿病患者。糖尿病患者被随机分为两组：缓慢复温组（n = 15）（平均复温速度：0.22℃±0.07℃/min，均值±标准差）或标准复温组（标准组）（n = 15）（平均复温速度：0.46℃±0.09℃/min，均值±标准差）。麻醉诱导后，将光纤血氧饱和度导管插入右颈静脉球部以持续监测SjvO₂。在九个时间点测量血流动力学变量以及动脉和颈静脉血气。所有患者在手术前一天及术后4个月接受一系列神经学和神经心理学测试。与麻醉诱导时相比，标准组在复温期SjvO₂值降低（P < 0.05）。在复温期，对照组标准复温和缓慢复温之间的SjvO₂值存在显著差异（标准对照组：51%±8%，缓慢对照组：58%±5%）（P < 0.05）。然而，糖尿病患者在复温期标准复温和缓慢复温之间的SjvO₂值没有差异。复温速率（比值比：0.8；95%置信区间：0.5 - 1.3；P = 0.6）与术后4个月的认知障碍无关。糖尿病（比值比：1.6；95%置信区间：0.9 - 2.6；P = 0.04）是术后4个月认知障碍的一个相关因素。我们得出结论，缓慢复温速率对糖尿病患者SjvO₂值降低及长期认知结局没有影响。
我们研究了复温速率对糖尿病和非糖尿病患者复温期颈内静脉血氧血红蛋白饱和度及长期认知结局的影响。缓慢复温无法预防糖尿病患者颈内静脉血氧血红蛋白饱和度降低的频率及不良认知结局。
