Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany.
Eur J Cardiothorac Surg. 2013 Feb;43(2):e37-43. doi: 10.1093/ejcts/ezs581. Epub 2012 Nov 4.
Near-infrared spectroscopy (NIRS) offers continuous non-invasive monitoring of regional tissue oxygenation. We evaluated NIRS monitoring during the postoperative course after superior cavopulmonary anastomosis in patients with hypoplastic left heart syndrome and anatomically related malformations.
Cerebral (cSO(2)) and somatic (sSO(2)) tissue oxygenations were recorded for 48 h and compared with routine measures of intensive care monitoring. Changes in parameters in the case of postoperative complications were evaluated.
Data were obtained from 32 patients. Median age at operation was 2.9 (1.5-10.0) months and weight was 5.3 ± 1.0 kg. Postoperative complications occurred in 7 patients (pulmonary artery thrombus n = 4, pneumothorax n = 1, cardiopulmonary resuscitation n = 1 and low-cardiac output n = 1). cSO(2) was 44 ± 14% at the end of the operation and reached its minimum of 40 ± 11% 2 h later (P = 0.018). Overall, cSO(2) was depressed early after surgery and increased from a mean of 42 ± 11% during the first 4 postoperative hours to 57 ± 8% in the last 4 h of the study period (P < 0.001). The sSO(2) decreased from 77 ± 11% during the early postoperative course to 68 ± 9% within the later course (P < 0.001). The cSO(2) correlated with the arterial partial pressure of oxygen (pO(2), r = 0.364, P < 0.001), with the arterial oxygen saturation (SaO(2), r = 0.547, P < 0.001) and with the central venous oxygen saturation providing the strongest correlation (SvO(2), r = 0.686, P < 0.001). Analysis of agreement between cSO(2) and SvO(2) measurements revealed a mean bias of 0.97 with limits of agreement between 19.8 and -17.9%. Inclusion of both cSO(2) and sSO(2) into a linear regression model slightly improved the prediction of SvO(2) from NIRS values (r = 0.706, P < 0.001). The mean values of cSO(2), sSO(2), SaO(2) and SvO(2) during the early postoperative period were lower in patients with complications (cSO(2): 45 ± 9 vs 29 ± 5%, P < 0.001; sSO(2): 80 ± 11 vs 70 ± 6%, P = 0.004; SaO(2): 76 ± 8 vs 66 ± 6%, P = 0.004; SvO(2): 48 ± 14 vs 32 ± 6%, P < 0.001).
NIRS technology allows inferring the global oxygenation from continuous non-invasive measurements of regional tissue oxygenation. The cSO(2) is lowered in the early postoperative course. Lower cSO(2) values in the early postoperative course may be predictive of postoperative complications.
近红外光谱（NIRS）可提供连续的非侵入性局部组织氧合监测。我们评估了左心发育不全综合征和解剖相关畸形患者行上腔静脉吻合术后的术后过程中 NIRS 监测。
记录 48 小时的脑（cSO（2））和躯体（sSO（2））组织氧合，并与重症监护监测的常规措施进行比较。评估术后并发症时参数的变化。
从 32 名患者中获得数据。手术时的中位年龄为 2.9（1.5-10.0）个月，体重为 5.3±1.0kg。7 名患者发生术后并发症（肺动脉血栓形成 n=4，气胸 n=1，心肺复苏 n=1，低心输出量 n=1）。手术结束时 cSO（2）为 44±14%，2 小时后达到最低值 40±11%（P=0.018）。总的来说，cSO（2）在手术后早期被抑制，并从术后前 4 小时的平均 42±11%增加到研究期间最后 4 小时的 57±8%（P<0.001）。sSO（2）从术后早期的 77±11%下降到后期的 68±9%（P<0.001）。cSO（2）与动脉部分氧分压（pO（2），r=0.364，P<0.001）、动脉血氧饱和度（SaO（2），r=0.547，P<0.001）和中心静脉血氧饱和度呈正相关（SvO（2），r=0.686，P<0.001）。对 cSO（2）和 SvO（2）测量值之间的一致性进行分析显示，平均偏差为 0.97，一致性界限为 19.8 和-17.9%。将 cSO（2）和 sSO（2）纳入线性回归模型略微提高了从 NIRS 值预测 SvO（2）的预测能力（r=0.706，P<0.001）。有并发症患者的 cSO（2）、sSO（2）、SaO（2）和 SvO（2）在术后早期的平均值较低（cSO（2）：45±9 比 29±5%，P<0.001；sSO（2）：80±11 比 70±6%，P=0.004；SaO（2）：76±8 比 66±6%，P=0.004；SvO（2）：48±14 比 32±6%，P<0.001）。
NIRS 技术允许从连续的局部组织氧合的非侵入性测量中推断出整体氧合。cSO（2）在术后早期下降。术后早期 cSO（2）值较低可能预示着术后并发症。
