Sørensen Henrik, Grocott Hilary P, Secher Niels H
Department of Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Anesthesia & Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada.
Clin Physiol Funct Imaging. 2016 Nov;36(6):427-435. doi: 10.1111/cpf.12244. Epub 2015 May 15.
Cerebral deoxygenation, as determined by near infrared spectroscopy (NIRS), seems to predict postoperative complications following cardiac surgery. We identify the type of non-vascular abdominal surgery associated with cerebral deoxygenation and/or hyperoxygenation, how such deviations affect patient outcome, and whether maintained cerebral oxygenation improves outcome.
A systematic literature search was performed on PubMed, EMBASE, Web of Science and Clinicaltrials.gov.
A total of 901 patients from 24 publications are described. A decrease in NIRS (>15% relative to baseline) manifested with reverse Trendelenburg's positioning and in 24% (median) of especially elderly patients undergoing open surgery and demonstrated a correlation to hospital stay (LOS). However, if cerebral deoxygenation was reversed promptly, improved postoperative cognitive function (28 versus 26; mini-mental state examination) and reduced LOS (14 versus 23 days) were seen. Also, during liver transplantation (LTx), impaired cerebral autoregulation (25%), cerebral deoxygenation in the anhepatic phase (36%) and cerebral hyperoxygenation with reperfusion of the grafted liver (14%) were identified by NIRS and could lead to adverse neurological outcome, that is seizures, transient hemiparesis and stroke.
NIRS seems important for predicting neurological complications associated with LTx. Also, surgery in reverse Trendelenburg's position and in other types of abdominal surgery about one-fourth of the patients are subjected to episodes of cerebral deoxygenation that seems to predict a poor outcome. Although there are currently only few studies available for patients going through abdominal surgery, the available evidence points to that it is an advantage to maintain the NIRS-determined cerebral oxygenation.
通过近红外光谱法（NIRS）测定的脑脱氧似乎可预测心脏手术后的术后并发症。我们确定与脑脱氧和/或高氧相关的非血管性腹部手术类型、此类偏差如何影响患者预后，以及维持脑氧合是否能改善预后。
在PubMed、EMBASE、科学网和Clinicaltrials.gov上进行了系统的文献检索。
共描述了来自24篇出版物的901例患者。NIRS降低（相对于基线>15%）在头高脚低位时出现，在接受开放手术的老年患者中尤其有24%（中位数）出现，并与住院时间（LOS）相关。然而，如果脑脱氧迅速得到纠正，则术后认知功能得到改善（简易精神状态检查评分：28对26），住院时间缩短（14天对23天）。此外，在肝移植（LTx）期间，通过NIRS可识别出脑自动调节受损（25%）、无肝期脑脱氧（36%）以及移植肝再灌注时脑高氧（14%），这些情况可能导致不良神经学后果，即癫痫发作、短暂性偏瘫和中风。
NIRS似乎对预测与LTx相关的神经并发症很重要。此外，在头高脚低位手术和其他类型的腹部手术中，约四分之一的患者会出现脑脱氧情况，这似乎预示着预后不良。尽管目前关于接受腹部手术患者的研究很少，但现有证据表明维持由NIRS测定的脑氧合是有益的。
