在新生儿主动脉弓手术中使用近红外光谱法监测选择性顺行性脑灌注
Monitoring of selective antegrade cerebral perfusion using near infrared spectroscopy in neonatal aortic arch surgery.
作者信息
Hofer A, Haizinger B, Geiselseder G, Mair R, Rehak P, Gombotz H
机构信息
General Hospital Linz, Departments of Anaesthesiology and Intensive Care, Linz, Austria.
出版信息
Eur J Anaesthesiol. 2005 Apr;22(4):293-8. doi: 10.1017/s0265021505000499.
BACKGROUND AND OBJECTIVE
To prevent neurological complications, low-flow antegrade cerebral perfusion (ACP) is used during repair of complex congenital heart defects. To overcome technical problems, continuous monitoring of cerebral blood flow and oxygenation is mandatory. The aim of the study was to evaluate the effect of different ACP flow rates on cerebral oxygen saturation obtained by near infrared spectroscopy.
METHODS
Ten consecutive neonates undergoing Norwood stage I were included. In addition to near infrared spectroscopy (Invos 5100; Somanetics Corp., USA) on both hemispheres, mean arterial pressure and transcranial Doppler flow velocity were measured continuously and arterial and jugular venous oxygen saturation intermittently. Cerebral oxygen extraction ratio was calculated. Measurement points were obtained after starting bypass, during ACP with flow rates of 30, 20 and 10 mL kg(-1) min(-1) and immediately after ACP. ANOVA and Tukey-Kramer multiple comparison test were used for statistics.
RESULTS
The near infrared spectroscopy signal could be obtained in all children at all measurement points, whereas transcranial Doppler failed in 1 neonate at a flow rate of 30 mL kg(-1)min(-1), in 3 neonates at 20 mL kg(-1) min(-1) and in 4 neonates at 10 mL kg(-1)min(-1). With the reduction of flow there was a significant decrease of cerebral oxygen saturation on both hemispheres (right: 78+/-8 to 72+/-9 and 66+/-8, P < 0.001; left: 71+/-7 to 65+/-7 and 60+/-7, P < 0.001), of jugular venous oxygen saturation (94+/-6 to 89+/-13 and 83+/-15, P < 0.001) and a significant increase in oxygen extraction ratio (9.1+/-8 to 14.8+/-14 and 21+/-16, P < 0.001) respectively, for 30, 20, 10 mL kg(-1)min(-1).
CONCLUSION
Near infrared spectroscopy reliably detects flow alterations during ACP with profound hypothermia.
背景与目的
为预防神经系统并发症，在复杂先天性心脏缺陷修复术中采用低流量顺行性脑灌注（ACP）。为克服技术问题，必须持续监测脑血流量和氧合情况。本研究旨在评估不同ACP流速对通过近红外光谱法获得的脑氧饱和度的影响。
方法
纳入连续10例接受诺伍德一期手术的新生儿。除了对双侧半球进行近红外光谱监测（美国索曼尼克斯公司的Invos 5100）外，还持续测量平均动脉压和经颅多普勒流速，并间歇性测量动脉和颈静脉氧饱和度。计算脑氧摄取率。测量点分别为体外循环开始后、流速为30、20和10 mL·kg⁻¹·min⁻¹的ACP期间以及ACP结束后立即进行。采用方差分析和Tukey-Kramer多重比较检验进行统计学分析。
结果
所有患儿在所有测量点均能获得近红外光谱信号，而经颅多普勒在流速为30 mL·kg⁻¹·min⁻¹时1例新生儿失败，流速为20 mL·kg⁻¹·min⁻¹时3例新生儿失败，流速为10 mL·kg⁻¹·min⁻¹时4例新生儿失败。随着流速降低，双侧半球的脑氧饱和度显著下降（右侧：从78±8降至72±9和66±8，P<0.001；左侧：从71±7降至65±7和60±7，P<0.001），颈静脉氧饱和度也显著下降（从94±6降至89±13和83±15，P<0.001），而氧摄取率则显著升高（分别从9.1±8升至14.8±14和21±16，P<0.001），分别对应30、20、10 mL·kg⁻¹·min⁻¹的流速。
结论
近红外光谱法能可靠地检测深低温下ACP期间的血流变化。
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