Özgök Ayşegül, Ulus Ahmet Tulga, Karadeniz Ümit, Demir Aslı, Kazancı Dilek, Özyalçın Sertan, Aydın Yasemen, Ünal Utku
Department of Anesthesiology and Reanimation, Ankara Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
Department of Cardiovascular Surgery, Ankara Yüksek İhtisas Training and Research Hospital, Ankara, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2020 Jan 23;28(1):84-91. doi: 10.5606/tgkdc.dergisi.2020.18685. eCollection 2020 Jan.
In this study, we aimed to investigate the effects of poor blood glucose control on the intraoperative cerebral system in patients undergoing coronary artery bypass grafting using various neuromonitors.
Between January 2011 and December 2011, a total of 40 adult patients (31 males, 9 females; mean age 58.8±9.2 years; range, 38 to 78 years) who were scheduled for elective coronary artery bypass grafting were included in the study. The patients were divided into four groups according to hemoglobin A1c levels as follows: Group 1 including non-diabetic controls (n=11); Group 2 including those with a hemoglobin A1c value of <7% (n=10); Group 3 including those with a hemoglobin A1c value of 7 to 10% (n=11); and Group 4 including those with a hemoglobin A1c value of ≥10% (n=8). Cerebral monitoring was performed with near-infrared spectroscopy and transcranial Doppler. Measurement periods were defined as follows: Before anesthesia induction (period 1), 10 min after anesthesia induction (period 2), during cannulation (period 3), 10 min after cardiopulmonary bypass (period 4), at 32°C temperature during cardiopulmonary bypass (period 5), at 36°C temperature during cardiopulmonary bypass (period 6), and at the end of the operation (period 7).
There was a significant difference in the near-infrared spectroscopy values in the cannulation period for both right (p<0.001) and left (p=0.002) sides and the mean transcranial Doppler flow velocity (p=0.002) in Group 4, compared to Group 1. The heart rate was found to be significantly lower in Group 4 in the cannulation period. The near-infrared spectroscopy values and transcranial Doppler blood flow velocity decreased in Group 4 in all measurement periods.
The results of our study show that, in patients with severe diabetes undergoing open heart surgery, heart rate decreases in the cannulation period due to possible autonomic neuropathy, and cerebral blood flow and oxygenation decrease. For these patients, particularly in the cannulation period, perfusion of both cerebral and other organs should be closely monitored and necessary interventions should be performed.
在本研究中，我们旨在使用各种神经监测仪，调查血糖控制不佳对冠状动脉旁路移植术患者术中脑系统的影响。
2011年1月至2011年12月期间，共有40例计划进行择期冠状动脉旁路移植术的成年患者（31例男性，9例女性；平均年龄58.8±9.2岁；范围38至78岁）纳入本研究。根据糖化血红蛋白水平将患者分为四组，如下：第1组包括非糖尿病对照组（n = 11）；第2组包括糖化血红蛋白值<7%的患者（n = 10）；第3组包括糖化血红蛋白值为7%至10%的患者（n = 11）；第4组包括糖化血红蛋白值≥10%的患者（n = 8）。使用近红外光谱和经颅多普勒进行脑监测。测量时间段定义如下：麻醉诱导前（时间段1）、麻醉诱导后10分钟（时间段2）、插管期间（时间段3）、体外循环后10分钟（时间段4）、体外循环期间32°C时（时间段5）、体外循环期间36°C时（时间段6）以及手术结束时（时间段7）。
与第1组相比，第4组在插管期右侧（p<0.001）和左侧（p = 0.002）的近红外光谱值以及平均经颅多普勒血流速度（p = 0.002）存在显著差异。发现第4组在插管期心率显著降低。第4组在所有测量时间段的近红外光谱值和经颅多普勒血流速度均下降。
我们的研究结果表明，在接受心脏直视手术的重度糖尿病患者中，由于可能存在自主神经病变，插管期心率降低，脑血流量和氧合减少。对于这些患者，特别是在插管期，应密切监测脑和其他器官的灌注情况，并进行必要的干预。
