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| 脑氧饱和度监测指导脑灌注对主动脉弓置换术后神经系统并发症的影响 |
| Effect of regional cerebral oxygen saturation monitoring combined with selective cerebral perfusion on the incidence of neurologic complications after aortic arch surgery |
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| DOI：10.12089/jca.2018.10.001 |
| 中文关键词: 近红外光谱 局部脑氧饱和度 主动脉置换术 中枢神经系统并发症 |
| 英文关键词: Near infrared spectroscopy Regional cerebral oxygen saturation Aortic arch replacement Neurologic complications |
| 基金项目:辽宁省自然科学基金（201602775） |
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| 中文摘要: |
目的 观察近红外光谱(near infrared spectroscopy,NIRS) 联合选择性顺行性脑灌注（selective antegrade cerebral perfusion,SACP）对主动脉弓部手术后中枢神经系统并发症发生率的影响。
方法 行主动脉弓置换术的患者95例,男70例,女25例,年龄37～61岁,ASA Ⅲ或Ⅳ级,随机分为两组: NIRS监测组(A组,n=48)和传统经验组(B组,n=47)。中低温停循环期间，调节脑灌注流量及压力，维持rSO2 60%~80%。A组当rSO2<55%时行双侧脑灌注；B组通过控制目标灌注压40~60 mmHg来调节脑灌注流量。采集围术期临床资料,比较两组术中、术后临床指标及术后并发症情况。
结果 A组手术时间、CPB时间、主动脉阻断时间、停循环时间、术后机械通气时间、ICU留观时间和术后住院时间短于B组,但差异无统计学意义。A组术后永久神经系统并发症发生率和术后脑血栓新发率明显低于B组(P<0.05);A组术后短暂神经系统并发症发生率低于B组,但差异无统计学意义。
结论 NIRS监测联合SACP可降低主动脉弓置换术后永久神经系统并发症发生率。 |
| 英文摘要: |
Objective To evaluate the clinical value of near infrared spectroscopy (NIRS) combined with selective antegrade cerebral perfusion (SACP) during aortic arch surgery.
Methods Ninety-five patients undergoing aortic surgery, 70 males and 25 females, aged 37 - 61 years, falling into ASA physical status Ⅲ or Ⅳ, were randomly divided into NIRS monitoring guidance group (group A, n = 48) and traditional experience group (group B, n = 47). During moderate hypothermic circulatory arrest, cerebral perfusion flow and pressure were controlled to keep the rSO2between 60％ to 80％ in group A, and bilateral antegrade cerebral perfusion was used if rSO2 lower than 55％. In group B, cerebral perfusion was moderated according to the target radial blood pressure ranged from 40 to 60 mmHg. Perioperative clinical data were collected and compared including the intraoperative and postoperative clinical indicators and the incidence of postoperative complications of the two groups.
Results Compared with group B, operating time, CPB, aortic cross-clamping time, circulatory arrest time, postoperative mechanical ventilation time, ICU stay time and postoperative hospital stay were reduced in group A, but the difference was no statistically significant. The permanent neurological dysfunction incidence and rates of new cerebral thrombosis were lower in group A than in group B (P < 0.05). Temporary neurological dysfunction rates were lower in group A than in group B, but the difference was not statistically significant.
Conclusion In the aortic arch surgery, regional NIRS monitoring of rSO2 combined with SACP optimizes the cerebral perfusion during moderate hypothermic circulatory arrest, and reduces the incidence of permanent neurologic complications after surgery. |
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