Zulueta Jose L, Vida Vladimiro L, Perisinotto Egle, Pittarello Demetrio, Stellin Giovanni
Department of Pharmacology and Anesthesiology, Institute of Anesthesia and Intensive Care, University of Padua, Padua, Italy.
J Card Surg. 2013 Jul;28(4):446-52. doi: 10.1111/jocs.12122. Epub 2013 Jun 5.
We report on the applicability of intraoperative regional oxygen saturation (rSO2) desaturation score by near-infrared spectroscopy in the early detection of postoperative low output state (LOS) in infants with congenital heart disease who underwent cardiac surgery.
Between July and October 2011 the intra- and immediate postoperative courses of 22 patients undergoing elective cardiac surgery for congenital heart disease were analyzed. The intraoperative cerebral and somatic rSO2 were measured and a rSO2 desaturation score calculated (by multiplying the rSO2 below 50% of the threshold by seconds). The aim of the study was to evaluate the applicability of intraoperative rSO2 de-saturation score in the early detection of postoperative LOS.
Thirteen of 22 patients (62%) had an intraoperative cerebral rSO2 desaturation score >3000% per second. Patients with a rSO2 de-saturation score >3000% per second had a significantly lower intraoperative central venous saturation (SvO2, p = 0.002), cardiac index (CI, p = 0.004), oxygen availability indexed (DO2I, p = 0.0004), and a significantly higher extraction of oxygen (ERO2, p = 0.0005) when compared to patients with a rSO2 desaturation score <3000% per second. Nine patients had postoperative LOS; all of them had an intraoperative rSO2 de-saturation score >3000% per second (9/13 patients, 69%; p = 0.001) requiring prompt treatment with major inotropic support, surface hypothermia, and extracorporeal membrane oxygenation (ECMO) support (n = 4). Twenty-one patients survived. One patient died from ventricular failure and inability to wean from ECMO support.
The intraoperative use of NIRS provided an early warning sign of hemodynamic or metabolic compromise, enabling early and rapid intervention to prevent or reduce the severity of potentially life-threatening complications.
我们报告了通过近红外光谱法测定术中局部氧饱和度（rSO2）降低分数在先天性心脏病心脏手术患儿术后低心排血量状态（LOS）早期检测中的适用性。
分析了2011年7月至10月期间22例行先天性心脏病择期心脏手术患者的术中及术后即刻病程。测量术中脑和躯体rSO2，并计算rSO2降低分数（将低于阈值50%的rSO2乘以秒数）。本研究的目的是评估术中rSO2降低分数在术后LOS早期检测中的适用性。
22例患者中有13例（62%）术中脑rSO2降低分数>3000%/秒。与rSO2降低分数<3000%/秒的患者相比，rSO2降低分数>3000%/秒的患者术中中心静脉血氧饱和度（SvO2，p = 0.002）、心脏指数（CI，p = 0.004）、氧输送指数（DO2I，p = 0.0004）显著降低，氧摄取率（ERO2，p = 0.0005）显著升高。9例患者出现术后LOS；所有患者术中rSO2降低分数>3000%/秒（9/13例患者，69%；p = 0.001），需要迅速给予大剂量血管活性药物支持、体表降温及体外膜肺氧合（ECMO）支持（n = 4）。21例患者存活。1例患者死于心室衰竭且无法撤离ECMO支持。
术中使用近红外光谱法可提供血流动力学或代谢受损的早期预警信号，从而实现早期快速干预，预防或减轻潜在危及生命并发症的严重程度。
