Rubio Alvaro, Hakami Lale, Münch Frank, Tandler René, Harig Frank, Weyand Michael
Department of Cardiac Surgery, Erlangen University Hospital, Erlangen, Germany.
J Card Surg. 2008 Sep-Oct;23(5):474-9. doi: 10.1111/j.1540-8191.2008.00644.x.
Real-time readings of the regional oxygen saturation (rSO(2)) using near-infrared spectroscopy (NIRS) during the aortic arch surgery can provide an early detection of perfusion or oxygenation abnormalities.
Aortic arch repair techniques using low-flow antegrade selective cerebral perfusion have been standardized to a certain degree. However, some of the often-stated beneficial effects have never been proven. Especially, the existence of an adequate continuous flow in both cerebral hemispheres during the surgical procedure still remains unclear as the monitoring of an effective perfusion remains a nonstandardized technique.
Seventeen patients underwent surgical reconstruction of the aortic arch due to aortic aneurysm surgery (adult group n = 8 patients) or of the hypoplastic aortic arch due to hypoplastic left heart syndrome (HLHS) or aortic coarctation (infant group n = 9 patients) under general anesthesia and mild hypothermia (adult group 28 degrees C; infant group 25 degrees C). Mean weights were 92.75 +/- 14.00 kg and 4.29 +/- 1.32 kg, and mean ages were 58.25 +/- 10.19 years and 55.67 +/- 51.11 days in the adult group and the infant group, respectively. The cerebral O(2) saturation measurement was performed by continuous plotting of the somatic reflectance oximetry of the frontal regional tissue on both cerebral hemispheres (rSO(2), INVOS; Somanetics Corporation, Troy, MI, USA).
During low-flow antegrade perfusion via innominate artery, continuous plots with similar values of O(2) saturation (rSO(2)) in both cerebral hemispheres were observed, whereas a decrease in the rSO(2) values below the desaturation threshold correlated with a displacement or an incorrect positioning of the arterial cannula in the right subclavian artery.
Continuous monitorization of the cerebral O(2) saturation during aortic arch surgery in adults and infants is a feasible technique to control an adequate cannula positioning and to optimize clinical outcomes avoiding neurological complications related to cerebral malperfusion.
在主动脉弓手术期间，使用近红外光谱（NIRS）实时读取局部氧饱和度（rSO₂）可早期发现灌注或氧合异常。
采用低流量顺行性选择性脑灌注的主动脉弓修复技术已在一定程度上实现标准化。然而，一些常提到的有益效果从未得到证实。特别是，手术过程中两个脑半球是否存在足够的持续血流仍不明确，因为有效灌注的监测仍是一项非标准化技术。
17例患者因主动脉瘤手术（成人组n = 8例）或因左心发育不全综合征（HLHS）或主动脉缩窄导致的主动脉弓发育不全（婴儿组n = 9例），在全身麻醉和轻度低温（成人组28℃；婴儿组25℃）下接受主动脉弓手术重建。成人组和婴儿组的平均体重分别为92.75±14.00kg和4.29±1.32kg，平均年龄分别为58.25±10.19岁和55.67±51.11天。通过连续绘制两个脑半球额叶区域组织的体反射血氧饱和度（rSO₂，INVOS；美国密歇根州特洛伊市索曼etics公司）来测量脑氧饱和度。
在通过无名动脉进行低流量顺行灌注期间，观察到两个脑半球的氧饱和度（rSO₂）值连续曲线相似，而rSO₂值降至去饱和阈值以下与右锁骨下动脉动脉插管移位或位置不正确相关。
在成人和婴儿主动脉弓手术期间持续监测脑氧饱和度是一种可行的技术，可控制插管位置合适并优化临床结果，避免与脑灌注不良相关的神经并发症。
