Suemori Tomohiko, Nagano Tatsuya, Sunoki Kohei, Shinohara Takako, Taga Naoyuki, Takeuchi Mamoru
Department of Pediatric Intensive Care and Anesthesia, Jichi Children's Medical Center Tochigi, Tochigi, Japan.
Paediatr Anaesth. 2022 Mar;32(3):413-420. doi: 10.1111/pan.14338. Epub 2021 Nov 29.
Despite providing cerebral tissue oxygen saturation (StO ), the lack of quantitative information for continuous wave near-infrared spectroscopy (CW-NIRS) is an obstacle in evaluating cerebral hemodynamic conditions. Time-domain NIRS (TD-NIRS) provides both StO and cerebral blood volume and has recently become clinically available.
To investigate if the additional monitoring of cerebral blood volume by TD-NIRS facilitates the understanding of cerebral hemodynamic conditions in patients with congenital heart disease.
Preoperative TD-NIRS values were retrospectively reviewed in patients who underwent a cardiac surgery or catheter examination. We compared the values between patients with single and two ventricles. Moreover, we investigated the association of these values with the demographic and clinical variables.
There was no significant difference in StO2 between single ventricle and two ventricles groups (median: 59.9 vs. 54.4, median difference [95% CI]: -4.06 [-9.90 to 2.90], p = .37). However, cerebral blood volume was significantly higher in the single ventricle group (median: 4.68 vs. 2.84, median difference [95% CI]: -2.01 [-2.88 to -1.06], p < .001). Spearman's rank correlation analysis demonstrated an association between StO2 and postmenstrual age (r = 0.35, p = .03). In contrast, cerebral blood volume was correlated with single ventricle physiology (r = 0.62, p < .001), postmenstrual age (r = 0.74, p < .001), central venous pressure (r = 0.38, p = .02), and SaO2 (r = -0.38, p = .02). The multivariable regression analysis identified the postmenstrual age, single ventricle physiology, and SaO2 as independent factors associated with cerebral blood volume. In the logistic analysis, cerebral blood volume was identified as a significant predictor of unfavorable conditions.
Cerebral blood volume monitoring detected differences in cerebral hemodynamic conditions, related to the age and the type of ventricle physiologies. However, the differences were not apparent in StO . The additional monitoring of cerebral blood volume by TD-NIRS would facilitate a better understanding of cerebral hemodynamic conditions in patients with congenital heart disease.
尽管连续波近红外光谱技术（CW-NIRS）能够提供脑组织氧饱和度（StO₂），但缺乏定量信息仍是评估脑血流动力学状况的一个障碍。时域近红外光谱技术（TD-NIRS）既能提供StO₂，又能提供脑血容量，且最近已在临床上应用。
研究TD-NIRS对脑血容量的额外监测是否有助于理解先天性心脏病患者的脑血流动力学状况。
对接受心脏手术或导管检查的患者术前TD-NIRS值进行回顾性分析。我们比较了单心室和双心室患者的值。此外，我们研究了这些值与人口统计学和临床变量之间的关联。
单心室组和双心室组之间的StO₂无显著差异（中位数：59.9对54.4，中位数差异[95%可信区间]：-4.06[-9.90至2.90]，p = 0.37）。然而，单心室组的脑血容量显著更高（中位数：4.68对2.84，中位数差异[95%可信区间]：-2.01[-2.88至-1.06]，p < 0.001）。Spearman等级相关分析显示StO₂与月经后年龄之间存在关联（r = 0.35，p = 0.03）。相比之下，脑血容量与单心室生理状态（r = 0.62，p < 0.001）、月经后年龄（r = 0.74，p < 0.001）、中心静脉压（r = 0.38，p = 0.02）和动脉血氧饱和度（r = -0.38，p = 0.02）相关。多变量回归分析确定月经后年龄、单心室生理状态和动脉血氧饱和度是与脑血容量相关的独立因素。在逻辑分析中，脑血容量被确定为不良状况的重要预测指标。
脑血容量监测发现了与年龄和心室生理类型相关的脑血流动力学状况差异。然而，这些差异在StO₂中并不明显。TD-NIRS对脑血容量的额外监测将有助于更好地理解先天性心脏病患者的脑血流动力学状况。
