Faculty Medicine and Health Science, Universiti Sains Islam Malaysia, Nilai, Negeri Sembilan, Malaysia.
Anaesthesiology Department and Intensive Care, National Heart Institute, Kuala Lumpur, Malaysia.
PLoS One. 2021 May 26;16(5):e0251157. doi: 10.1371/journal.pone.0251157. eCollection 2021.
Cardiothoracic surgeries are life-saving procedures but often it results in various complications. Intraoperative cerebral oximetry monitoring used to detect regional cerebral oxygen saturation (rScO2) is a non-invasive method that provides prognostic importance in cardiac surgery. The main aim of the present study was to evaluate the association of intraoperative cerebral oxygen monitoring during cardiac surgery on postoperative complications. This was a case-controlled retrospective study conducted on adult patients, who underwent open-heart surgery in National Heart Institute, Malaysia. The case group comprised patients on protocolized cerebral oximetry monitoring. They were treated using a standardized algorithm to maintain rScO2 not lower than 20% of baseline rScO2. The control group comprised patients with matched demographic background, preoperative risk factors, and type of surgical procedures. Propensity score stratification was utilized to contend with selection bias. Retrospective analysis was performed on 240 patients (case group) while comparing it to 407 patients (control group). The non-availability of cerebral oximetry monitoring during surgery was the prominent predictor for all outcome of complications; stroke (OR: 7.66), renal failure needing dialysis (OR: 5.12) and mortality (OR: 20.51). Postoperative complications revealed that there were significant differences for risk of mortality (p<0.001, OR = 20.51), renal failure that required dialysis (p<0.001, OR = 5.12) and stroke (p <0.05, OR = 7.66). Protocolized cerebral oximetry monitoring during cardiothoracic surgeries was found to be associated with lower incidence of stroke, renal failure requiring dialysis and mortality rate.
心胸外科手术是救命的程序,但往往会导致各种并发症。术中脑氧饱和度监测用于检测局部脑氧饱和度(rScO2)是一种非侵入性的方法,为心脏手术提供预后重要性。本研究的主要目的是评估心脏手术期间术中脑氧监测对术后并发症的影响。这是一项在马来西亚国家心脏研究所进行的成人患者的病例对照回顾性研究,他们接受了心脏直视手术。病例组包括接受方案性脑氧监测的患者。他们接受了标准化的治疗方案,以维持 rScO2 不低于基础 rScO2 的 20%。对照组包括具有匹配的人口统计学背景、术前危险因素和手术类型的患者。采用倾向评分分层来应对选择偏差。对 240 名患者(病例组)进行回顾性分析,并与 407 名患者(对照组)进行比较。术中缺乏脑氧监测是所有并发症结果的显著预测因素;中风(OR:7.66)、需要透析的肾衰竭(OR:5.12)和死亡率(OR:20.51)。术后并发症显示,死亡率(均<0.001,OR=20.51)、需要透析的肾衰竭(均<0.001,OR=5.12)和中风(均<0.05,OR=7.66)的风险存在显著差异。在心胸外科手术中进行方案性脑氧监测与较低的中风、肾衰竭和死亡率发生率有关。