Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.
J Cardiothorac Vasc Anesth. 2012 Dec;26(6):1015-21. doi: 10.1053/j.jvca.2012.07.011. Epub 2012 Sep 18.
This "real-world" study was designed to assess the patterns of regional cerebral oxygen saturation (rSO(2)) change during adult cardiac surgery. A secondary objective was to determine any relation between perioperative rSO(2) (baseline and during surgery) and patient characteristics or intraoperative variables.
Prospective, observational, multicenter, nonrandomized clinical study.
Cardiac operating rooms at 3 academic medical centers.
Ninety consecutive adult patients presenting for cardiac surgery with or without cardiopulmonary bypass.
Patients received standard care at each institution plus bilateral forehead recordings of cerebral oxygen saturation with the 7600 Regional Oximeter System (Nonin Medical, Plymouth, MN).
The average baseline (before induction) rSO(2) was 63.9 ± 8.8% (range 41%-95%); preoperative hematocrit correlated with baseline rSO(2) (0.48% increase for each 1% increase in hematocrit, p = 0.008). The average nadir (lowest recorded rSO(2) for any given patient) was 54.9 ± 6.6% and was correlated with on-pump surgery, baseline rSO(2), and height. Baseline rSO(2) was found to be an independent predictor of length of stay (hazard ratio 1.044, confidence interval 1.02-1.07, for each percentage of baseline rSO(2)).
In cardiac surgical patients, lower baseline rSO(2) value, on-pump surgery, and height were significant predictors of nadir rSO(2), whereas only baseline rSO(2) was a predictor of postoperative length of stay. These findings support previous research on the predictive value of baseline rSO(2) on length of stay and emphasize the need for further research regarding the clinical relevance of baseline rSO(2) and intraoperative changes.
本“真实世界”研究旨在评估成人心脏手术期间区域性脑氧饱和度（rSO₂）变化的模式。次要目标是确定围手术期 rSO₂（基线和手术期间）与患者特征或术中变量之间的任何关系。
前瞻性、观察性、多中心、非随机临床研究。
3 家学术医疗中心的心脏手术室。
连续 90 例成人患者，拟行心脏手术，伴或不伴心肺转流。
各机构的患者接受标准护理，外加使用 7600 区域血氧计系统（明尼苏达州普利茅斯的 Nonin Medical）进行双侧额部脑氧饱和度记录。
平均基线（诱导前）rSO₂为 63.9±8.8%（范围 41%-95%）；术前血细胞比容与基线 rSO₂相关（血细胞比容每增加 1%，rSO₂增加 0.48%，p=0.008）。平均最低点（每位患者记录的最低 rSO₂）为 54.9±6.6%，与体外循环手术、基线 rSO₂和身高相关。发现基线 rSO₂是住院时间的独立预测因素（rSO₂基线每增加 1%，风险比为 1.044，95%置信区间为 1.02-1.07）。
在心脏手术患者中，较低的基线 rSO₂值、体外循环手术和身高是最低点 rSO₂的显著预测因素，而只有基线 rSO₂是术后住院时间的预测因素。这些发现支持了先前关于基线 rSO₂对住院时间的预测价值的研究，并强调需要进一步研究基线 rSO₂和术中变化的临床相关性。
