Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Ann Thorac Surg. 2013 Jun;95(6):2114-20; discussion 2120-1. doi: 10.1016/j.athoracsur.2013.01.076. Epub 2013 Apr 23.
Superior vena cava oxygen saturation monitoring in the early postoperative period after the Norwood procedure (NP) has been associated with improved survival and decreased adverse events (AE). There is no data describing inferior vena cava saturation (Sivo2) monitoring after NP. We sought to investigate the utility of intermittent Sivo2 monitoring after NP and to assess the correlation of Sivo2 with renal near-infrared spectroscopy (rNIRS). We hypothesized failure to achieve Sivo2 greater than 45% within the first 4 hours after NP is predictive of AE, and that rNIRS correlates with Sivo2.
A retrospective study of 26 consecutive NP patients who received postoperative management with Sivo2 monitoring according to a strict protocol was conducted. Primary outcome was AE, defined as cardiopulmonary resuscitation, extracorporeal membrane oxygenation, death before discharge, or residual surgical defects.
Ten (38%) patients had one or more AE; mortality was 23%. On admission to the cardiac intensive care unit, patients with AE had lower Sivo2 (45% ± 9.4% versus 62% ± 12.0%; p < 0.001) and lower rNIRS (56 ± 6.5 versus 77 ± 7.2; p < 0.001). At 4 hours, 90% of AE patients had an Sivo2 less than 45% versus 6% of non-AE patients. Both Sivo2 and rNIRS were highly predictive of AE: the area under the receiver-operating characteristic curve was greater than 0.86 and 0.95, respectively. Two hours after admission, an Sivo2 less than 45% predicted AE with a specificity of 93%, a sensitivity of 70%, and a positive predictive value of 82%. The Sivo2 was strongly correlated with rNIRS (r = 0.81).
Intermittent Sivo2 can be used to guide early postoperative NP management; rNIRS is an accurate continuous, noninvasive surrogate for Sivo2. An Sivo2 of less than 45% in the first 4 hours after the NP is predictive of AE.
在 Norwood 手术后（NP）的早期术后期间监测上腔静脉血氧饱和度与存活率提高和不良事件（AE）减少有关。目前尚无数据描述 NP 后下腔静脉饱和度（Sivo2）的监测。我们试图研究 NP 后间歇性 Sivo2 监测的效用，并评估 Sivo2 与肾近红外光谱（rNIRS）的相关性。我们假设 NP 后 4 小时内未能达到 Sivo2 大于 45%，则预示着 AE，并且 rNIRS 与 Sivo2 相关。
对 26 例连续接受 NP 治疗并根据严格方案进行 Sivo2 监测的患者进行回顾性研究。主要结局为 AE，定义为心肺复苏、体外膜氧合、出院前死亡或残留手术缺陷。
10 例（38%）患者有 1 种或多种 AE；死亡率为 23%。入住心脏重症监护病房时，AE 患者的 Sivo2 较低（45%±9.4%比 62%±12.0%；p<0.001），rNIRS 较低（56±6.5 比 77±7.2；p<0.001）。4 小时时，90%的 AE 患者 Sivo2<45%，而非 AE 患者为 6%。Sivo2 和 rNIRS 均高度预测 AE：受试者工作特征曲线下面积分别大于 0.86 和 0.95。入院后 2 小时，Sivo2<45%预测 AE 的特异性为 93%，敏感性为 70%，阳性预测值为 82%。Sivo2 与 rNIRS 密切相关（r=0.81）。
间歇性 Sivo2 可用于指导 NP 术后早期管理；rNIRS 是 Sivo2 的准确连续、非侵入性替代物。NP 后 4 小时内 Sivo2<45%预测 AE。
