经近红外光谱仪测量，低温体外心肺复苏期间脑氧代谢和血液动力学的变化：一项初步研究。
Changes of cerebral oxygen metabolism and hemodynamics during ECPR with hypothermia measured by near-infrared spectroscopy: a pilot study.
机构信息
Department of Cardiology, Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital, 1-8-13 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan.
出版信息
Adv Exp Med Biol. 2013;789:121-128. doi: 10.1007/978-1-4614-7411-1_17.
BACKGROUND
The 2010 CPR Guidelines recommend that extracorporeal cardiopulmonary resuscitation (ECPR) using an emergency cardiopulmonary bypass (CPB) should be considered for patients with cardiac arrest. However, it is not yet clear whether this therapy can improve cerebral circulation and oxygenation in these patients. To clarify this issue, we evaluated changes of cerebral blood oxygenation (CBO) during ECPR using near-infrared spectroscopy (NIRS).
METHODS
We employed NIRS to measure CBO in the bilateral frontal lobe in patients transported to the emergency room (ER) after out-of-hospital cardiac arrest between November 2009 and June 2011.
RESULTS
Fifteen patients met the above criteria. The tissue oxygenation index (TOI) on arrival at the ER was 36.5 %. This increased to 67.8 % during ECPR (P < 0.001). The one patient whose TOI subsequently decreased had a favorable neurological outcome.
CONCLUSION
Increase of TOI during ECPR might reflect an improvement in cerebral blood flow, while decrease of TOI after ECPR might reflect oxygen utilization by the brain tissue as a result of neuronal cell survival. NIRS may be useful for monitoring cerebral hemodynamics and oxygen metabolism during CPR.
背景
2010 年心肺复苏指南建议对发生心搏骤停的患者考虑使用体外心肺复苏（ECPR）联合紧急体外循环（CPB）。然而，目前尚不清楚这种治疗方法是否可以改善此类患者的脑循环和氧合。为了阐明这一问题，我们使用近红外光谱（NIRS）评估了 ECPR 期间脑血氧变化（CBO）。
方法
我们采用 NIRS 对 2009 年 11 月至 2011 年 6 月期间因院外心搏骤停而被送往急诊室（ER）的患者双侧额叶的 CBO 进行了测量。
结果
符合上述标准的患者共有 15 例。到达 ER 时的组织氧合指数（TOI）为 36.5%。在 ECPR 过程中，TOI 增加至 67.8%（P < 0.001）。其中 1 例患者在 ECPR 后 TOI 降低，但其神经功能结局良好。
结论
ECPR 期间 TOI 的增加可能反映了脑血流量的改善，而 ECPR 后 TOI 的降低可能反映了神经元存活导致的脑组织氧利用。NIRS 可能有助于监测 CPR 期间的脑血流动力学和氧代谢。
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