比较两种体外循环降温策略对新生儿和婴儿颈静脉血氧饱和度的影响。

Comparing two strategies of cardiopulmonary bypass cooling on jugular venous oxygen saturation in neonates and infants.

作者信息

Kern F H, Ungerleider R M, Schulman S R, Meliones J N, Schell R M, Baldwin B, Hickey P R, Newman M F, Jonas R A, Greeley W J

机构信息

Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.

出版信息

Ann Thorac Surg. 1995 Nov;60(5):1198-202. doi: 10.1016/0003-4975(95)00700-U.

DOI:10.1016/0003-4975(95)00700-U

PMID:8526599

Abstract

BACKGROUND

Cerebral protection during deep hypothermic circulatory arrest is predicted on efficient and complete cerebral cooling. Institutions approach cooling quite differently. We compared two different cooling strategies in terms of measured jugular venous bulb saturations in 39 infants undergoing deep hypothermic cardiopulmonary bypass to evaluate the effect of institutional cooling practices on jugular venous bulb saturation, an indirect measure of cerebral cooling efficiency.

METHODS

The patients were grouped based on the method of core cooling. In group A (n = 17), core cooling was achieved rapidly by setting the water bath temperature of the heat exchanger at 4 degrees to 5 degrees C, and the patient was cooled until rectal temperature and nasopharyngeal temperature were 15 degrees C or lower. In group B (n = 22), the heat exchanger was initially set at 18 degrees C and slowly lowered to 12 degrees C. Hypothermic temperatures of 12 degrees C were maintained until the nasopharyngeal temperature was 18 degrees C or less and the rectal temperature was 20 degrees C or lower. Once cooling was complete, blood samples were analyzed by cooximetry for determination of arterial oxygen saturation and jugular venous bulb saturation.

RESULTS

In group A, the measured jugular venous bulb saturation was 98.0% +/- 0.9% and the oxygen saturation to jugular venous bulb saturation difference was 0.3% +/- 0.5%, measured at the time that institutional cooling objectives were achieved (total cooling time, 15.0 +/- 0.45 minutes). In group B, jugular venous bulb saturation was 86.2% +/- 12% and the oxygen saturation to jugular venous bulb saturation difference was 10.8% +/- 12.2%, measured at the time that institutional cooling objectives were achieved (total cooling time, 17.5 +/- 1.1 minutes (p < 0.01).

CONCLUSIONS

Differences in cardiopulmonary bypass cooling techniques may alter the rate at which jugular bulb saturations rise. We believe this represents an indirect measure of the efficiency of brain cooling and therefore of cerebral protection.

摘要

背景

深度低温循环停搏期间的脑保护取决于有效且完全的脑降温。不同机构采取的降温方法差异很大。我们比较了39例接受深度低温体外循环的婴儿在两种不同降温策略下的颈静脉球饱和度，以评估机构降温措施对颈静脉球饱和度（脑降温效率的间接指标）的影响。

方法

根据核心降温方法对患者进行分组。A组（n = 17）通过将热交换器的水浴温度设定在4℃至5℃来快速实现核心降温，患者被冷却至直肠温度和鼻咽温度为15℃或更低。B组（n = 22），热交换器最初设定为18℃，然后缓慢降至12℃。维持12℃的低温直至鼻咽温度为18℃或更低且直肠温度为20℃或更低。降温完成后，通过血氧定量法分析血样以测定动脉血氧饱和度和颈静脉球饱和度。

结果

A组在达到机构降温目标时（总降温时间，15.0±0.45分钟）测得的颈静脉球饱和度为98.0%±0.9%，动脉血氧饱和度与颈静脉球饱和度之差为0.3%±0.5%。B组在达到机构降温目标时（总降温时间，17.5±1.1分钟）测得的颈静脉球饱和度为86.2%±12%，动脉血氧饱和度与颈静脉球饱和度之差为10.8%±12.2%（p<0.01）。