心脏手术后长时间术后脑氧饱和度降低：一项前瞻性观察研究。

Prolonged postoperative cerebral oxygen desaturation after cardiac surgery: A prospective observational study.

机构信息

From the Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia (LC, LB, LT, SLC, EAO, FY, TN, NL, SW, GME, RB), Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland (LC), Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Prahran, Victoria, Australia (LC, FY, NL, RB), Service de médecine intensive et réanimation, hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France (LB), Department of Anaesthesia, Austin Hospital, Melbourne, Victoria, Australia (DH, LW), Dipartimento di Scienze dell'emergenza, anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A, Gemelli IRCCS (SLC), Università Cattolica del Sacro Cuore, Rome, Italy (SLC), Department of Intensive Care, Siriraj Hospital, Mahidol University, Bangkok, Thailand (TN), Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland (NL), Department of Surgery, Austin Hospital (AM, JW), School of Medicine, The University of Melbourne (RB) and Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital and The University of Melbourne, Melbourne, Victoria, Australia (RB).

出版信息

Eur J Anaesthesiol. 2021 Sep 1;38(9):966-974. doi: 10.1097/EJA.0000000000001391.

DOI:10.1097/EJA.0000000000001391

PMID:33186311

Abstract

BACKGROUND

Near-infrared spectroscopy (NIRS) is used routinely to monitor cerebral tissue oxygen saturation (SctO2) during cardiopulmonary bypass (CPB) but is rarely employed outside the operating room. Previous studies indicate that patients are at risk of postoperative cerebral oxygen desaturation after cardiac surgery.

OBJECTIVES

We aimed to assess perioperative and postoperative changes in NIRS-derived SctO2 in cardiac surgery patients.

DESIGN

Prospective observational study.

SETTING

The study was conducted in a tertiary referral university hospital in Australia from December 2017 to December 2018.

PATIENTS

We studied 34 adult patients (70.6% men) undergoing cardiac surgery requiring CPB and a reference group of 36 patients undergoing non-cardiac surgical procedures under general anaesthesia.

MAIN OUTCOME MEASURES

We measured SctO2 at baseline, during and after surgery, and then once daily until hospital discharge, for a maximum of 7 days. We used multivariate linear mixed-effects modelling to adjust for all relevant imbalances between the two groups.

RESULTS

In the cardiac surgery group, SctO2 was 63.7% [95% confidence interval (CI), 62.0 to 65.5] at baseline and 61.0% (95% CI, 59.1 to 62.9, P = 0.01) on arrival in the ICU. From day 2 to day 7 after cardiac surgery, SctO2 progressively declined. At hospital discharge, SctO2 was significantly lower than baseline, at 53.5% (95% CI, 51.8 to 55.2, P < 0.001). In the reference group, postoperative SctO2 was not significantly different from baseline. On multivariable analysis, cardiac surgery, peripheral vascular disease and time since the operation were associated with greater cerebral desaturation, whereas higher haemoglobin concentrations were associated with slightly better cerebral oxygenation.

CONCLUSION

After cardiac surgery on CPB, but not after non-cardiac surgery, most patients experience prolonged cerebral desaturation. Such postoperative desaturation remained unresolved 7 days after surgery. The underlying mechanisms and time to resolution of such cerebral desaturations require further investigation.

摘要

背景

近红外光谱（NIRS）常用于体外循环（CPB）期间监测脑氧饱和度（SctO2），但在手术室之外很少使用。先前的研究表明，心脏手术后患者存在术后脑氧饱和度降低的风险。

目的

评估心脏手术患者围手术期和术后 NIRS 衍生 SctO2 的变化。

设计

前瞻性观察性研究。

地点

该研究于 2017 年 12 月至 2018 年 12 月在澳大利亚的一家三级转诊大学医院进行。

患者

我们研究了 34 名接受 CPB 心脏手术的成年患者（70.6%为男性）和 36 名接受全身麻醉下非心脏手术的参考组患者。

主要观察指标

我们在基线、手术中和手术后测量 SctO2，然后每天测量一次，直到出院，最长 7 天。我们使用多变量线性混合效应模型来调整两组之间的所有相关不平衡。

结果

在心脏手术组中，SctO2 在基线时为 63.7%（95%置信区间，62.0 至 65.5），在到达 ICU 时为 61.0%（95%置信区间，59.1 至 62.9，P=0.01）。从心脏手术后第 2 天到第 7 天，SctO2 逐渐下降。在出院时，SctO2 明显低于基线，为 53.5%（95%置信区间，51.8 至 55.2，P<0.001）。在参考组中，术后 SctO2 与基线相比无显著差异。多变量分析表明，心脏手术、外周血管疾病和手术时间与脑氧合降低有关，而较高的血红蛋白浓度与脑氧合稍好有关。