Suemori Tomohiko, Skowno Justin, Horton Steve, Bottrell Stephen, Butt Warwick, Davidson Andrew J
Anaesthesia and Pain Management Research Group, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.
Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Paediatr Anaesth. 2016 Feb;26(2):182-9. doi: 10.1111/pan.12800. Epub 2015 Dec 1.
Near-infrared spectroscopy (NIRS) provides an assessment of cerebral oxygenation and tissue hemoglobin concentration.
The aim of this study was to investigate whether the cerebral oxygenation and hemoglobin concentration measured with NIRS could predict outcomes after pediatric cardiac surgery.
We conducted a retrospective observational study in 399 patients who underwent pediatric cardiac surgery. Associations were determined between postoperative outcome and preoperative and postoperative cerebral tissue oxygenation index (TOI), postoperative normalized tissue hemoglobin index (nTHI), concentration changes in oxygenated hemoglobin (Δ[HbO2 ]) and deoxygenated hemoglobin (Δ[HHb]).
Thirty-nine children had major postoperative morbidity and 12 died. Using Spearman's correlation analysis, postoperative lower TOI and higher Δ[HHb] were associated with longer stays in the Intensive Care Unit (ICU) (r = -0.48, P < 0.001, r = 0.31, P < 0.001, respectively) and longer duration of intubation (r = -0.48, P < 0.001, r = 0.31, P < 0.001, respectively) and higher probability of death determined by the Risk Adjusted Classification for Congenital Heart Surgery (RACHS-1) (r = -0.39, P < 0.001, r = 0.23, P < 0.001, respectively). In multivariate regression analysis, postoperative TOI was independently associated with major morbidity and mortality and Δ[HHb] was independently associated with major morbidity. In receiver operating characteristic analysis, postoperative TOI and Δ[HHb] predicted major morbidity (Area under the curve [AUC] = 0.72, 0.68, respectively) and mortality (AUC = 0.81, 0.69, respectively).
Lower TOI or higher [HHb] at the end of surgery and higher RACHS-1 category predicted worse outcomes.
近红外光谱（NIRS）可用于评估脑氧合和组织血红蛋白浓度。
本研究旨在探讨通过NIRS测量的脑氧合和血红蛋白浓度能否预测小儿心脏手术后的结局。
我们对399例行小儿心脏手术的患者进行了一项回顾性观察研究。确定术后结局与术前及术后脑组织氧合指数（TOI）、术后标准化组织血红蛋白指数（nTHI）、氧合血红蛋白浓度变化（Δ[HbO2]）和脱氧血红蛋白浓度变化（Δ[HHb]）之间的关联。
39名儿童术后出现严重并发症，12名死亡。采用Spearman相关性分析，术后较低的TOI和较高的Δ[HHb]与在重症监护病房（ICU）停留时间延长相关（r分别为-0.48，P<0.001；r为0.31，P<0.001），与插管时间延长相关（r分别为-0.48，P<0.001；r为0.31，P<0.001），并且与先天性心脏病手术风险调整分类（RACHS-1）确定的死亡概率较高相关（r分别为-0.39，P<0.001；r为0.23，P<0.001）。在多因素回归分析中，术后TOI与严重并发症和死亡率独立相关，Δ[HHb]与严重并发症独立相关。在受试者工作特征分析中，术后TOI和Δ[HHb]可预测严重并发症（曲线下面积[AUC]分别为0.72、0.68）和死亡率（AUC分别为0.81、0.69）。
手术结束时较低的TOI或较高的[HHb]以及较高的RACHS-1分类预示着更差的结局。
