Ogino H, Ueda Y, Sugita T, Morioka K, Sakakibara Y, Matsubayashi K, Nomoto T
Department of Cardiovascular Surgery, Tenri Hospital, Nara, Japan.
Eur J Cardiothorac Surg. 1998 Oct;14(4):415-8. doi: 10.1016/s1010-7940(98)00177-8.
To assess the value of monitoring of regional cerebral oxygen saturation (rSO2) during aortic arch surgery using continuous retrograde cerebral perfusion (CRCP) in conjunction with profound hypothermic circulatory arrest (HCA).
The rSO2 of 12 consecutive patients was monitored non-invasively using near-infrared spectroscopy (NIRS) and the data were analyzed statistically.
The mean duration of HCA with CRCP was 62-/+14.1 min. The mean CRCP flow rate was 226+/-163 ml/min. Surgical outcomes were favorable with only a single hospital death (8.3%). However, the rSO2 decreased gradually in all patients during HCA, even combined with CRCP, and fell to 46+/-8.7% on average. It did not change so greatly before HCA and returned finally to its initial level at the end of re-warming. Only one patient developed a permanent neurologic deficit; this patient showed the greatest decrease of rSO2 from 56% to 29% after the longest HCA of 88 min. Two parameters, End-rSO2 (the ratio of post- to pre-HCA rSO2) and delta-rSO2 (the rate of decrease from preto post-HCA rSO2) were obtained since the initial values of rSO2 before surgery differed. There were linear correlations between the CRCP flow rate and each of these two parameters. A multiple regression analysis also revealed a linear equation relating the parameters, which allowed prediction of the safe duration of HCA in different conditions of CRCP and a more favorable adjustment of the CRCP condition in each patient.
The study suggests that the combination of HCA and CRCP has a limit of safe duration in spite of its potential usefulness for brain protection, and that rSO2 monitored by NIRS is useful in testing for adequate brain protection. It is hoped that monitoring of rSO2 can facilitate prediction of the safe duration of HCA with CRCP and a more favorable adjustment of CRCP.
评估在主动脉弓手术中，使用持续逆行脑灌注（CRCP）联合深度低温停循环（HCA）时监测局部脑氧饱和度（rSO2）的价值。
使用近红外光谱（NIRS）对连续12例患者的rSO2进行无创监测，并对数据进行统计分析。
CRCP辅助下HCA的平均持续时间为62±14.1分钟。CRCP的平均流速为226±163毫升/分钟。手术结果良好，仅1例医院死亡（8.3%）。然而，在HCA期间，所有患者的rSO2均逐渐下降，即使联合CRCP也是如此，平均降至46±8.7%。在HCA前rSO2变化不大，复温结束时最终恢复到初始水平。仅1例患者出现永久性神经功能缺损；该患者在88分钟最长HCA后，rSO2从56%降至29%，降幅最大。由于术前rSO2的初始值不同，获得了两个参数，即终末rSO2（HCA后与HCA前rSO2的比值）和ΔrSO2（HCA前至HCA后rSO2的下降率）。CRCP流速与这两个参数均呈线性相关。多元回归分析还揭示了一个将这些参数关联起来的线性方程，该方程可预测不同CRCP条件下HCA的安全持续时间，并能更合理地调整每位患者的CRCP条件。
该研究表明，尽管HCA和CRCP联合应用对脑保护有潜在作用，但其安全持续时间存在限度，并且通过NIRS监测rSO2有助于检测脑保护是否充分。希望对rSO2的监测能够促进对CRCP辅助下HCA安全持续时间的预测，并更合理地调整CRCP。
