Yotsumoto G, Toyohira H, Moriyama Y, Watanabe S, Iguro Y, Masuda H, Hisatomi K, Shimokawa S, Taira A
Second Department of Surgery, Kagoshima University Faculty of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Jul;45(7):970-3.
To evaluate selective cerebral perfusion (SCP) for brain protection, the redox state of cytochrome oxidase (Cyt. aa3) in brain tissue were studied in 27 patients with thoracic aortic repair. The redox state of Cyt. aa3 was monitored by near infrared spectroscopy (NIRS) (OM-110, Shimazu). There were no significant changes in the Cyt. aa3 redox state in 13 (Group I), the oxidation state of Cyt. aa3 decreased then recovered to control levels in 12 (Group II), and the oxidation state decreased but did not recover in 2 patients (Group III). Postoperative cerebral damage was observed in 5 patients; blindness occurred in one patient in Group I (8.3%), 2 patients developed hemiplegia in Group II (15.4%), and the 2 patients in Group III failed to reawaken (100%). The incidence of cerebral damage was significantly higher in Group III than in Groups I and II (p < 0.05). We conclude that monitoring the redox state of Cyt. aa3 using NIRS is useful in predicting postoperative cerebral damage. However, it is necessary to increase the number of measurement sites since NIRS can reflect the state in only a small area of the brain.
为评估选择性脑灌注（SCP）对脑保护的作用，我们对27例胸主动脉修复患者脑组织中细胞色素氧化酶（Cyt. aa3）的氧化还原状态进行了研究。通过近红外光谱（NIRS）（岛津OM-110）监测Cyt. aa3的氧化还原状态。13例患者（I组）的Cyt. aa3氧化还原状态无显著变化；12例患者（II组）的Cyt. aa3氧化状态先降低后恢复至对照水平；2例患者（III组）的氧化状态降低但未恢复。5例患者术后出现脑损伤；I组1例患者失明（8.3%），II组2例患者出现偏瘫（15.4%），III组2例患者未苏醒（100%）。III组脑损伤发生率显著高于I组和II组（p < 0.05）。我们得出结论，使用NIRS监测Cyt. aa3的氧化还原状态有助于预测术后脑损伤。然而，由于NIRS只能反映脑内小区域的状态，因此有必要增加测量部位的数量。
