心脏手术体外循环期间使用经颅多普勒快速评估脑自动调节下限：一项可行性研究

Quick Assessment of the Lower Limit of Cerebral Autoregulation Using Transcranial Doppler during Cardiopulmonary Bypass in Cardiac Surgery: A Feasibility Study.

作者信息

Desebbe Olivier, Bachelard Etienne, Deperdu Marie, Manet Romain, Alexander Brenton, Beuvelot Johanne, Nloga Joseph, Joosten Alexandre, Gergelé Laurent

机构信息

Department of Anesthesiology and Intensive Care, Ramsay Sante, Sauvegarde Clinic, 69009 Lyon, France.

Department of Anesthesiology and Intensive Care, Lyon Sud University Hospital, Hospices Civils de Lyon, 69495 Pierre Bénite, France.

出版信息

Rev Cardiovasc Med. 2023 May 31;24(6):156. doi: 10.31083/j.rcm2406156. eCollection 2023 Jun.

DOI:10.31083/j.rcm2406156

PMID:39077528

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11264067/

Abstract

BACKGROUND

During cardiac surgery, maintaining a mean arterial pressure (MAP) within the range of cerebral autoregulation (CA) may prevent postoperative morbidity. The lower limit of cerebral autoregulation (LLA) can be determined using the mean velocity index (Mx). The standard Mx is averaged over a ten second period ( ) while using a two second averaging period ( ) is faster and may record more rapid variations in LLA. The objective of this study is to compare a quick determination of LLA (qLLA) using with the reference LLA (rLLA) using .

METHODS

Single center, retrospective, observational study. Patients undergoing cardiac surgery with cardiopulmonary bypass. From January 2020 to April 2021, perioperative transcranial doppler measuring cerebral artery velocity was placed on cardiac surgery patients in order to correlate with continuous MAP values. Calculation of each patient's Mx was manually determined after the surgery and qLLA and rLLA were then calculated using a threshold value of Mx 0.4.

RESULTS

55 patients were included. qLLA was found in 78% of the cases versus 47% for rLLA. Despite a -3 mmHg mean bias, limits of agreement were large [-19 mmHg (95% CI: -13; -25), and +13 mmHg (95% CI: +6; +19)]. There was an important interobserver variability (kappa rLLA = 0.46; 95% CI: 0.24-0.66; and Kappa qLLA = 0.36; 95% CI: 0.20-0.52).

CONCLUSIONS

Calculation of qLLA is feasible. However, the large limits of agreement and significant interobserver variability prevent any clinical utility or interchangeability with rLLA.

摘要

背景

在心脏手术期间，将平均动脉压（MAP）维持在脑自动调节（CA）范围内可能预防术后发病。脑自动调节下限（LLA）可使用平均速度指数（Mx）来确定。标准Mx是在10秒时间段内进行平均（），而使用2秒平均时间段（）速度更快，并且可能记录LLA中更快速的变化。本研究的目的是比较使用快速确定LLA（qLLA）与使用确定的参考LLA（rLLA）。

方法

单中心、回顾性、观察性研究。接受体外循环心脏手术的患者。从2020年1月至2021年4月，对心脏手术患者进行围手术期经颅多普勒测量脑动脉速度，以便与连续MAP值相关联。术后手动确定每位患者的Mx，然后使用Mx阈值0.4计算qLLA和rLLA。

结果

纳入55例患者。78%的病例中发现了qLLA，而rLLA为47%。尽管平均偏差为-3 mmHg，但一致性界限较大[-19 mmHg（95% CI：-13；-25），以及+13 mmHg（95% CI：+6；+19）]。观察者间存在重要的变异性（kappa rLLA = 0.46；95% CI：0.24 - 0.66；kappa qLLA = 0.36；95% CI：0.20 - 0.52）。