Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
Department of Pediatrics and Anesthesiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex.
J Thorac Cardiovasc Surg. 2014 Jan;147(1):483-9. doi: 10.1016/j.jtcvs.2013.07.069. Epub 2013 Sep 26.
Optimizing blood pressure using near-infrared spectroscopy monitoring has been suggested to ensure organ perfusion during cardiac surgery. Near-infrared spectroscopy is a reliable surrogate for cerebral blood flow in clinical cerebral autoregulation monitoring and might provide an earlier warning of malperfusion than indicators of cerebral ischemia. We hypothesized that blood pressure below the limits of cerebral autoregulation during cardiopulmonary bypass would be associated with major morbidity and operative mortality after cardiac surgery.
Autoregulation was monitored during cardiopulmonary bypass in 450 patients undergoing coronary artery bypass grafting and/or valve surgery. A continuous, moving Pearson's correlation coefficient was calculated between the arterial pressure and low-frequency near-infrared spectroscopy signals and displayed continuously during surgery using a laptop computer. The area under the curve of the product of the duration and magnitude of blood pressure below the limits of autoregulation was compared between patients with and without major morbidity (eg, stroke, renal failure, mechanical lung ventilation >48 hours, inotrope use >24 hours, or intra-aortic balloon pump insertion) or operative mortality.
Of the 450 patients, 83 experienced major morbidity or operative mortality. The area under the curve of the product of the duration and magnitude of blood pressure below the limits of autoregulation was independently associated with major morbidity or operative mortality after cardiac surgery (odds ratio, 1.36; 95% confidence interval, 1.08-1.71; P = .008).
Blood pressure management during cardiopulmonary bypass using physiologic endpoints such as cerebral autoregulation monitoring might provide a method of optimizing organ perfusion and improving patient outcomes from cardiac surgery.
使用近红外光谱监测优化血压，以确保心脏手术期间器官灌注。近红外光谱在临床脑自动调节监测中是脑血流的可靠替代指标，并且可能比脑缺血指标更早地提供灌注不良的预警。我们假设体外循环期间血压低于脑自动调节范围与心脏手术后的主要发病率和手术死亡率相关。
在 450 例行冠状动脉旁路移植术和/或瓣膜手术的患者中监测体外循环期间的自动调节。使用笔记本电脑在手术期间连续显示，通过计算动脉压和低频近红外光谱信号之间的连续移动 Pearson 相关系数来监测自动调节。将血压低于自动调节范围的持续时间和幅度的乘积的曲线下面积与有或无主要发病率（例如中风、肾衰竭、机械通气>48 小时、儿茶酚胺使用>24 小时或主动脉内球囊泵插入）或手术死亡率的患者进行比较。
在 450 例患者中，83 例出现主要发病率或手术死亡率。血压低于自动调节范围的持续时间和幅度的乘积的曲线下面积与心脏手术后的主要发病率或手术死亡率独立相关（优势比，1.36；95%置信区间，1.08-1.71；P=0.008）。
使用生理终点（如脑自动调节监测）进行体外循环期间的血压管理可能提供一种优化器官灌注和改善心脏手术患者预后的方法。
