Monitoring brain oxygen saturation during coronary bypass surgery: A randomized, prospective study
Monitoring brain oxygen saturation during coronary bypass surgery: A randomized, prospective study
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DOI：
10.1213/01.ane.0000246814.29362.f4
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发表时间：
2007-01-01
影响因子：
5.7
通讯作者：
Fox, Stephanie
中科院分区：
文献类型：
--
作者：
Murkin, John M.;Adams, Sandra J.;Fox, Stephanie
背景：脑缺氧。与各种不良的系统性结果相关。我们假设，通过使用大脑作为指标器官，干预。方法：200例冠状动脉搭桥术患者随机分为两组，一组采用主动显示和治疗干预方案进行术中脑局部氧饱和度（rSO（2））监测（干预组，n = 100），另一组采用盲法rSO（2）监测（对照组，n = 100）。预先定义的临床结果进行了评估，由一个盲observer.RESULTS：显着更多的患者在对照组表现出长期的大脑去饱和（P = 0.014）和更长的时间在重症监护室（P = 0.029）与干预患者。不良并发症的总体发生率没有差异，但对照组患者的主要器官发病率或死亡率（死亡、通气> 48小时、中风、心肌梗死、返回重新探查）明显高于干预组患者（P = 0.048）。与无此类并发症的患者相比，发生主要器官并发症或死亡的患者的基线和平均rSO（2）较低，脑去饱和度较高，重症监护和术后住院时间较长。术中rSO（2）与术后住院时间呈显著负相关（r（2）= 0.29），术后住院时间>= 10 d的患者术后住院时间>
BACKGROUND: Cerebral deoxygenation. is associated with various adverse systemic outcomes. We hypothesized, by using the brain as an index organ, that interventions. to improve cerebral oxygenation would have systemic benefits in cardiac surgical patients.METHODS: Two-hundred coronary artery bypass patients were randomized to either intraoperative cerebral regional oxygen saturation (rSO(2),) monitoring with active display and treatment intervention protocol (intervention, n = 100), or underwent blinded rSO(2) monitoring (control, n = 100). Predefined clinical outcomes were assessed by a blinded observer.RESULTS: Significantly more patients in the control group demonstrated prolonged cerebral desaturation (P = 0.014) and longer duration in the intensive care unit (P = 0.029) versus intervention patients. There was no difference in overall incidence of adverse complications, but significantly more control patients had major organ morbidity or mortality (death, ventilation > 48 h, stroke, myocardial infarction, return for re-exploration) versus intervention group patients (P = 0.048). Patients experiencmg major organ morbidity or mortality had lower baseline and mean rSO(2), more cerebral desaturations and longer lengths of stay in the intensive care it and postoperative hospitalization, than patients without such complications. There was a significant (r(2) = 0.29) inverse correlation between intraoperative rSO(2), and duration of postoperative hospitalization in patients requiring >= 10 days postoperative length of stay.CONCLUSION: Monitoring cerebral rSO(2) in coronary artery bypass patients avoids profound cerebral desaturation and is associated with significantly fewer incidences of major organ dysfunction.