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体外循环平均全身氧输送可能与低温主动脉手术期间的神经认知功能保护有关。

Cardiopulmonary Bypass Mean Global Oxygen Delivery May Be Associated with Neurocognitive Preservation during Hypothermic Aortic Surgery.

作者信息

Garrison Larry

机构信息

Mayo Clinic, Rochester, Minnesota.

出版信息

J Extra Corpor Technol. 2020 Dec;52(4):289-294. doi: 10.1182/ject-2000035.

Abstract

The purpose of this retrospective research was to investigate the relationship between mean global oxygen delivery (DO) and neurocognitive function in adult patients who presented for aortic surgery with deep hypothermic circulatory arrest using cardiopulmonary bypass (CPB). From a pool of 132 patients, data from 100 CPB patients from 2012 to 2014 aged 50 years or older were randomly selected and analyzed, and global DO on CPB was used to categorize patients into those for whom the mean indexed cerebral oxygen delivery (DOi) was either ≥272 mL O/min/m (critical DO [DO]) or less than DO. Ten patients experienced either stroke or expired in the perioperative course. The proportion of patients with evidence of neurocognitive preservation was 98.3% in the group in which the DO was met, compared with 80.6% in the group where DO was not met ( [1, 100] = 3.27, = .07). Potentially, because of causes other than DO, the subset of patients with stroke and/or death were removed, and data from 90 cases were analyzed, and a global mean DOi value of 239.9 mL O/min/m was identified. A larger sample size with controls may yield deeper insights into the hypothesis that a mean global CPB DOi of 239.9 mL O/min/m may play a role in predicting neurocognitive preservation in this patient population.

摘要

这项回顾性研究的目的是调查在使用体外循环(CPB)进行深低温停循环主动脉手术的成年患者中,平均全身氧输送(DO)与神经认知功能之间的关系。从132例患者中,随机选取并分析了2012年至2014年100例年龄50岁及以上接受CPB治疗患者的数据,并根据CPB期间的全身DO将患者分为平均脑氧输送指数(DOi)≥272 mL O/min/m(临界DO [DO])组和低于DO组。10例患者在围手术期发生中风或死亡。达到DO的组中神经认知功能保留证据的患者比例为98.3%,而未达到DO的组中这一比例为80.6%([1, 100] = 3.27,P = 0.07)。可能由于DO以外的原因,将发生中风和/或死亡的患者子集排除,分析了90例患者的数据,确定全身平均DOi值为239.9 mL O/min/m。更大样本量并设置对照组可能会更深入地洞察以下假设:即全身CPB平均DOi值239.9 mL O/min/m可能在预测该患者群体的神经认知功能保留方面发挥作用。

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