Nollert G, Möhnle P, Tassani-Prell P, Uttner I, Borasio G D, Schmoeckel M, Reichart B
Department of Cardiac Surgery, University of Munich, Germany.
Thorac Cardiovasc Surg. 1995 Oct;43(5):260-4. doi: 10.1055/s-2007-1013224.
In 41 patients undergoing cardiac operations with extracorporeal circulation, oxidized cytochrome a,a3(CtO2), deoxygenated hemoglobin (Hb), and oxygenated hemoglobin (HbO2) were measured in brain tissue by near-infrared spectrophotometry (NIRS) intraoperatively. Monitoring also included electroencephalography (EEG) and jugular-bulb venous saturation (SBJO2). All operations were performed using membrane oxygenators, moderate hypothermia (26-28 degrees C) and pH alpha-stat management. During cardiopulmonary bypass (CPB) CtO2 and HbO2) were reduced, reaching minimal values when rewarming was instituted. At the end of the operation CtO2 and HbO2 had regained initial levels. During CPB, arterial PCO2, pH, and temperature were closely related to CtO2 (r = 1000, r = -0.964 and 0.929 respectively; p < 0.001, p < 0.001, and p < 0.003 respectively). Neuropsychological testing by the Mini-Mental-State Test indicated reversible postoperative neuropsychological deficits in four patients. There patients had a lower CtO2 minimum compared to those without these deficits (-4.5 mumol/L v. -0.7 mumol/L; p = 0.036). These findings support the hypothesis that neuropsychological deficits in patients after cardiac surgery can be caused by intraoperative cerebral hypoxia.
在41例接受体外循环心脏手术的患者中，术中通过近红外分光光度法（NIRS）测量脑组织中的氧化细胞色素a,a3（CtO2）、脱氧血红蛋白（Hb）和氧合血红蛋白（HbO2）。监测还包括脑电图（EEG）和颈静脉球血氧饱和度（SBJO2）。所有手术均使用膜式氧合器、中度低温（26 - 28摄氏度）和pHα-稳态管理。在体外循环（CPB）期间，CtO2和HbO2降低，在开始复温时达到最小值。手术结束时，CtO2和HbO2恢复到初始水平。在CPB期间，动脉血二氧化碳分压、pH值和温度与CtO2密切相关（r分别为1000、-0.964和0.929；p分别<0.001、<0.001和<0.003）。通过简易精神状态测试进行的神经心理学测试表明，4例患者术后存在可逆性神经心理学缺陷。与没有这些缺陷的患者相比，这4例患者的CtO2最小值更低（-4.5 μmol/L对-0.7 μmol/L；p = 0.036）。这些发现支持了心脏手术后患者神经心理学缺陷可能由术中脑缺氧引起的假说。
