近红外光谱监测的微血管反应性在心脏手术患者麻醉诱导后受损：一项观察性研究。

Microvascular reactivity monitored with near-infrared spectroscopy is impaired after induction of anaesthesia in cardiac surgery patients: An observational study.

机构信息

From the Department of Anaesthesiology (LV, KGL, SGDH, ATM); Department of Cardiac Surgery, Ghent University Hospital, Gent, Belgium (FMDS); and Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium (KVV).

出版信息

Eur J Anaesthesiol. 2017 Oct;34(10):688-694. doi: 10.1097/EJA.0000000000000684.

DOI:10.1097/EJA.0000000000000684

PMID:28834795

Abstract

BACKGROUND

Induction of anaesthesia causes significant macrohaemodynamic changes, but little is known about its effects on the microcirculation. However, alterations in microvascular perfusion are known to be associated with impaired tissue oxygenation and organ dysfunction. Microvascular reactivity can be assessed with vascular occlusion testing, which evaluates the response of tissue oxygen saturation to transient ischaemia and reperfusion.

OBJECTIVE

The aim of the current study was to evaluate the effects of an opioid-based anaesthesia induction on microvascular reactivity. We hypothesised that despite minimal blood pressure changes, microvascular function would be impaired.

DESIGN

Prospective, observational study.

SETTING

Single-centre, tertiary university teaching hospital, Belgium.

PATIENTS

Thirty-five adult patients scheduled for elective coronary artery bypass grafting surgery.

INTERVENTION

Microvascular reactivity was assessed before and 30 min after anaesthesia induction by means of vascular occlusion testing and near-infrared spectroscopy.

MAIN OUTCOME MEASURES

Tissue oxygen saturations, desaturation rate, recovery time (time from release of cuff to the maximum value) and rate of recovery were determined.

RESULTS

Data are expressed as median (minimum to maximum). Tissue oxygen saturation was higher after induction of anaesthesia [70 (54 to 78) vs. 73 (55 to 94)%, P = 0.015]. Oxygen consumption decreased after induction, appreciable by the higher minimum tissue oxygen saturation [45 (29 to 69) vs. 53 (28 to 81)%, P < 0.001] and the slower desaturation rate [11 (4 to 18) vs. 9 (5 to 16)% min, P < 0.001]. After induction of anaesthesia, recovery times were longer [40 (20 to 120) vs. 48 (24 to 356) s, P = 0.004] and the rate of recovery was lower [114 (12 to 497) vs. 80 (3 to 271)% min, P < 0.001].

CONCLUSION

After induction of anaesthesia, oxygen consumption was decreased. The longer recovery times and slower rates of recovery indicate impaired microvascular reactivity after induction of anaesthesia.

TRIAL REGISTRATION

The research project was registered at ClinicalTrials.gov (NCT02034682).

摘要

背景

麻醉诱导会引起显著的宏观血液动力学变化，但对于其对微循环的影响知之甚少。然而，已知微血管灌注的改变与组织氧合受损和器官功能障碍有关。微血管反应性可以通过血管闭塞试验来评估，该试验评估组织氧饱和度对短暂性缺血和再灌注的反应。

目的

本研究旨在评估基于阿片类药物的麻醉诱导对微血管反应性的影响。我们假设，尽管血压变化很小，但微血管功能仍会受损。

设计

前瞻性、观察性研究。

地点

比利时的一家单中心、三级大学教学医院。

患者

35 名择期行冠状动脉旁路移植术的成年患者。

干预措施

通过血管闭塞试验和近红外光谱技术，在麻醉诱导前和诱导后 30 分钟评估微血管反应性。

主要观察指标

测定组织氧饱和度、去饱和度率、恢复时间（从袖口释放到最大值的时间）和恢复率。

结果

数据以中位数（最小值至最大值）表示。麻醉诱导后组织氧饱和度升高[70（54 至 78）比 73（55 至 94）%，P=0.015]。诱导后耗氧量下降，表现为最低组织氧饱和度升高[45（29 至 69）比 53（28 至 81）%，P<0.001]和去饱和度率减慢[11（4 至 18）比 9（5 至 16）%/min，P<0.001]。麻醉诱导后，恢复时间延长[40（20 至 120）比 48（24 至 356）s，P=0.004]，恢复速度减慢[114（12 至 497）比 80（3 至 271）%/min，P<0.001]。