Vohra Hunaid A, Modi Amit, Ohri Sunil K
Department of Cardiac Surgery, Wessex Cardiothoracic Centre, Southampton General Hospital, Southampton SO16 6YD, UK.
Interact Cardiovasc Thorac Surg. 2009 Aug;9(2):318-22. doi: 10.1510/icvts.2009.206367. Epub 2009 May 15.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of cerebral regional oxygen saturation (rSO(2)) monitoring during cardiac surgery can lead to improved clinical outcomes. Altogether 488 papers were found using the reported search, of which eight presented the best evidence to answer the clinical question. The author, year, journal, country of study, study type, patient group studied, relevant outcomes, results and study weaknesses were tabulated. Four prospective and another four retrospective studies involving adult and paediatric patients undergoing various cardiac surgical procedures were selected. These have demonstrated that prolonged intra-operative cerebral desaturations are associated with adverse neurological outcomes and prolonged hospital stay. Further, interventions carried out by thoughtful use of the cerebral oximeter are associated with significant reduction in neurologic injury, major organ morbidity and mortality (MOMM) and duration of hospital stay. Some studies have indicated decreased ventilation and intensive care unit (ICU) stay times as well. Clinical benefit and the lack of use-associated risk of injury at a modest expense support the use of this device routinely in patients undergoing cardiac surgery.
根据结构化方案撰写了一篇心脏外科最佳证据主题文章。所探讨的问题是，心脏手术期间使用脑局部氧饱和度（rSO₂）监测是否能改善临床结局。通过报告的检索共找到488篇论文，其中8篇提供了回答该临床问题的最佳证据。对作者、年份、期刊、研究国家、研究类型、所研究的患者群体、相关结局、结果及研究不足进行了列表整理。选取了四项前瞻性研究和另外四项回顾性研究，涉及接受各种心脏手术的成人和儿童患者。这些研究表明，术中脑氧饱和度长时间降低与不良神经学结局及住院时间延长相关。此外，合理使用脑氧饱和度仪进行干预与神经损伤、主要器官发病率和死亡率（MOMM）的显著降低以及住院时间缩短相关。一些研究还表明通气时间和重症监护病房（ICU）住院时间也有所减少。临床获益以及在费用适度的情况下不存在与使用相关的损伤风险，支持在接受心脏手术的患者中常规使用该设备。
