Candan Tulay, Candan Muhammet, Yildiz Cenk Eray, Gumustas Mehmet, Erenturk Selim, Yalcinbas Yusuf Kenan
Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Medipol Mega University Hospital, Cardiovascular Surgery, Istanbul, Turkey.
Arch Med Sci Atheroscler Dis. 2020 Dec 29;5:e320-e331. doi: 10.5114/amsad.2020.103377. eCollection 2020.
Compromise of tissue oxygenation during surgery is associated with increased mortality and morbidity in the postoperative period in patients with congenital cardiac disorders. It may be monitored with near-infrared spectroscopy (NIRS). We aimed to evaluate the tissue oxygenation and factors which may affect it by bilateral cerebral and somatic NIRS levels during cardiopulmonary bypass and to compare the NIRS values of cyanotic and acyanotic patient groups.
Two groups of patients with cyanotic and acyanotic congenital heart diseases were included in the study. Each group consisted of 15 patients between 0 and 5 years of age. All data were collected following anesthesia induction (T1), the 10th (T2) and 30 min (T3) of cardiopulmonary bypass (CPB), every 30 min during CPB (T4, T5, T6) and 1 h after (TS). Bilateral and somatic NIRS, blood gases, mean arterial pressure, and temperatures were recorded.
Left and right somatic NIRS values in groups at all measurements did not differ significantly. Left and right cerebral NIRS values at T2 and T3 in cyanotic patients were significantly higher than in acyanotic patients. Mean arterial pressure and lactate levels at T1 and T3 measurements were responsible for left cerebral NIRS changes and mean arterial pressure on right cerebral NIRS values.
Monitorization of tissue perfusion has critical importance during CPB of patients with congenital heart defects. Oxygenation may easily and reliably be measured with NIRS. Cerebral and somatic NIRS are more pronounced in cyanotic patients and cerebral NIRS is strongly associated with mean arterial pressure and circulating lactate levels.
先天性心脏病患者手术期间组织氧合受损与术后死亡率和发病率增加有关。可通过近红外光谱（NIRS）进行监测。我们旨在通过体外循环期间双侧脑和躯体NIRS水平评估组织氧合及其可能的影响因素，并比较青紫型和非青紫型患者组的NIRS值。
本研究纳入了两组患有青紫型和非青紫型先天性心脏病的患者。每组由15名0至5岁的患者组成。所有数据在麻醉诱导后（T1）、体外循环（CPB）第10分钟（T2）和30分钟（T3）、CPB期间每隔30分钟（T4、T5、T6）以及术后1小时（T7）收集。记录双侧和躯体NIRS、血气、平均动脉压和体温。
所有测量时两组的左右躯体NIRS值无显著差异。青紫型患者在T2和T3时的左右脑NIRS值显著高于非青紫型患者。T1和T3测量时的平均动脉压和乳酸水平是左脑NIRS变化的原因，而平均动脉压是右脑NIRS值变化的原因。
在先天性心脏缺陷患者的体外循环期间，组织灌注监测至关重要。使用NIRS可以轻松、可靠地测量氧合情况。青紫型患者的脑和躯体NIRS更为明显，且脑NIRS与平均动脉压和循环乳酸水平密切相关。
