Mohandas B S, Jagadeesh A M, Vikram S B
Department of Cardiac Anesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
Ann Card Anaesth. 2013 Apr-Jun;16(2):102-6. doi: 10.4103/0971-9784.109740.
We studied the usefulness of regional cerebral oxygen saturation (rSO 2 ) monitoring during cardiopulmonary bypass (CPB) and evaluated effects of cerebral oxygen desaturation on the postoperative neurological outcome.
100 patients were randomly allocated to either control or intervention group. In the control group rSO 2 was recorded continuously, but the attending anesthesiologist was blinded. In the intervention group specific interventions were initiated in case of cerebral desaturation. Neurocognitive testing was done using a simplified antisaccadic eye movement test (ASEM) and mini-mental state examination (MMSE). Data was analyzed using Chi-square test, and unpaired t-test.
In both the groups rSO 2 declined during CPB. The decrease in rSO 2 was significant ( P < 0.001) in the control group compared to the intervention group. In the intervention group the rSO 2 mainly responded to an increase in mean arterial pressure. The area under the curve below threshold rSO 2 was significantly more ( P < 0.0001) in the control group compared to intervention group and a significant decrease in the MMSE and ASEM scores occurred in control group at one week and three months postoperatively.
Monitoring of rSO 2 during CPB can significantly decrease the incidence of postoperative neurocognitive decline.
我们研究了体外循环（CPB）期间局部脑氧饱和度（rSO₂）监测的有效性，并评估了脑氧饱和度降低对术后神经功能转归的影响。
100例患者被随机分配至对照组或干预组。对照组持续记录rSO₂，但主麻医生对此不知情。干预组在出现脑氧饱和度降低时采取特定干预措施。使用简化的反跳眼动试验（ASEM）和简易精神状态检查表（MMSE）进行神经认知测试。采用卡方检验和非配对t检验对数据进行分析。
两组患者在CPB期间rSO₂均下降。与干预组相比，对照组rSO₂的下降更为显著（P<0.001）。干预组中，rSO₂主要对平均动脉压的升高做出反应。与干预组相比，对照组低于阈值rSO₂的曲线下面积显著更大（P<0.0001），且对照组在术后1周和3个月时MMSE和ASEM评分出现显著下降。
CPB期间监测rSO₂可显著降低术后神经认知功能下降的发生率。
