Ejike Janeth C, Schenkman Kenneth A, Seidel Kristy, Ramamoorthy Chandra, Roberts Joan S
Loma Linda University School of Medicine, Loma Linda, CA, USA.
Pediatr Crit Care Med. 2006 Mar;7(2):154-8. doi: 10.1097/01.PCC.0000200969.65438.83.
To observe the effects of right carotid artery ligation and variations in extracorporeal life support (ECLS) flow on regional cerebral oxygenation index (rSO2i) measured using near infrared spectroscopy.
Prospective observational study.
Tertiary children's hospital.
Eleven neonatal and pediatric patients requiring veno-arterial ECLS support between June 2000 and March 2003.
Near infrared spectroscopy probe placement on left and right frontal regions of patients undergoing ECLS, before vessel cannulation or within 24 hrs of initiation of ECLS.
Regional cerebral oxygenation was measured every minute for 72 hrs or until the patient was decannulated. The effect of cannulation on rSO2i from each hemisphere of the brain and the relationship between ECLS flow and rSO2i during ECLS support and "trialing off" periods were determined. Ligation of the right carotid artery resulted in a 12-25% decrease in rSO2i from baseline in the right frontal region for a duration ranging from 17 to 45 mins before returning toward baseline. No substantial change in the left frontal region rSO2i was detected during cannulation. Following this depression in rSO2i on the right, there was a transient increase above baseline in rSO2i observed in both hemispheres on initiating ECLS. No correlation between ECLS flow and rSO2i was found over the 72-hr period. Periods of "trialing off" ECLS were not related to any change in rSO2i in either hemisphere.
This study demonstrated no relationship between ECLS flow and rSO2i changes during the 72-hr observation period. A brief period of cerebral oxygen desaturation of the right frontal region at the time of right carotid ligation was seen in all three study patients examined during cannulation, followed by an increased rSO2i with initiation of ECLS flow. Near infrared spectroscopy measurement may offer an important adjunct for neurologic monitoring of ECLS patients.
观察右颈动脉结扎及体外生命支持（ECLS）流量变化对使用近红外光谱法测量的局部脑氧合指数（rSO2i）的影响。
前瞻性观察研究。
三级儿童医院。
2000年6月至2003年3月期间11例需要静脉-动脉ECLS支持的新生儿和儿科患者。
在接受ECLS治疗的患者进行血管插管前或开始ECLS治疗后24小时内，将近红外光谱探头置于患者左右额叶区域。
每分钟测量局部脑氧合72小时，或直至患者拔管。确定插管对大脑每个半球rSO2i的影响以及ECLS支持期间和“试脱机”期间ECLS流量与rSO2i之间的关系。右颈动脉结扎导致右额叶区域rSO2i较基线水平降低12% - 25%，持续17至45分钟，然后恢复至基线水平。插管期间未检测到左额叶区域rSO2i有实质性变化。右额叶区域rSO2i出现这种降低之后，开始ECLS时两个半球的rSO2i均观察到短暂高于基线水平的增加。在72小时期间未发现ECLS流量与rSO2i之间存在相关性。“试脱机”ECLS的时间段与任何一个半球的rSO2i变化均无关。
本研究表明在72小时观察期内ECLS流量与rSO2i变化之间无相关性。在插管期间检查的所有3例研究患者中，右颈动脉结扎时右额叶区域均出现短暂的脑氧饱和度降低，随后随着ECLS流量开始增加rSO2i。近红外光谱测量可能为ECLS患者的神经监测提供重要辅助手段。
