Department of Cardiovascular Surgery, School of Medicine, Kitasato University, Sagamihara, Japan; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
Department of Cardiovascular Surgery, School of Medicine, Kitasato University, Sagamihara, Japan.
J Thorac Cardiovasc Surg. 2018 Dec;156(6):2251-2257. doi: 10.1016/j.jtcvs.2018.08.097. Epub 2018 Sep 28.
High-flow regional cerebral perfusion (HFRCP) provides cerebral and somatic oxygen delivery through collateral vessels during aortic arch repair in small children; however, optimal flow conditions during HFRCP have not been established. We sought to identify markers of peripheral perfusion during HFRCP.
Between 2009 and 2016, in total 20 consecutive pediatric patients undergoing aortic arch repair with HFRCP were enrolled in this prospective, observational study. Median age was 20 days (range, 6-116 days); median body weight was 2.77 kg (range, 1.8-4.98 kg). Oxygen delivery ratio (DoR) was calculated as the oxygen delivery during HFRCP divided by the oxygen delivery before HFRCP. Regional oxygen saturations on the forehead and on the thigh (rSoT) were monitored during HFRCP, and postoperative creatinine kinase and lactate concentrations were measured as postoperative outcomes. Multivariate analyses were performed to clarify the effectiveness of DoR and rSoT as markers of peripheral perfusion during HFRCP.
No deaths or neurologic impairments occurred. Multivariate analysis showed that the lowest rSoT (P = .005) and cardiopulmonary bypass time (P = .012) predicted postoperative creatinine kinase concentration. DoR was the only factor to predict postoperative lactate concentration (P < .001). Receiver operating characteristic analysis showed that DoR less than 0.66 predicted risk of high postoperative lactate concentration (>5.0 mmol/L), with area under the curve of 0.95.
For aortic arch repair in small children, rSoT and DoR during HFRCP are useful markers for predicting peripheral perfusion. Maintaining higher DoR during HFRCP minimizes postoperative increases in lactate and creatinine kinase concentrations.
高流量区域性脑灌注（HFRCP）可在小儿主动脉弓修复期间通过侧支血管提供脑和躯体的氧输送；然而，HFRCP 期间的最佳血流条件尚未确定。我们试图确定 HFRCP 期间外周灌注的标志物。
2009 年至 2016 年间，共纳入 20 例连续接受 HFRCP 治疗的小儿主动脉弓修复患者进行前瞻性观察研究。中位年龄为 20 天（范围，6-116 天）；中位体重为 2.77kg（范围，1.8-4.98kg）。氧输送率（DoR）定义为 HFRCP 期间的氧输送除以 HFRCP 前的氧输送。在 HFRCP 期间监测前额和大腿的局部氧饱和度（rSoT），并测量术后肌酸激酶和乳酸浓度作为术后结果。进行多变量分析以明确 DoR 和 rSoT 作为 HFRCP 期间外周灌注标志物的有效性。
无死亡或神经功能障碍发生。多变量分析显示，最低 rSoT（P=.005）和体外循环时间（P=.012）预测术后肌酸激酶浓度。DoR 是唯一预测术后乳酸浓度的因素（P<.001）。受试者工作特征分析显示，DoR 小于 0.66 预测高术后乳酸浓度（>5.0mmol/L）的风险，曲线下面积为 0.95。
对于小儿主动脉弓修复，HFRCP 期间的 rSoT 和 DoR 是预测外周灌注的有用标志物。在 HFRCP 期间维持较高的 DoR 可最大程度地减少术后乳酸和肌酸激酶浓度的升高。
