Near-infrared spectroscopy for monitoring cerebral ischemia during selective cerebral perfusion
Near-infrared spectroscopy for monitoring cerebral ischemia during selective cerebral perfusion
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DOI：
10.1016/j.ejcts.2004.06.014
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发表时间：
2004-11-01
影响因子：
3.4
通讯作者：
Imai, K
中科院分区：
文献类型：
--
作者：
Orihashi, K;Sueda, T;Imai, K
目的：为了减少心血管手术后的神经系统并发症，必须防止脑血管栓塞的发生，并及时发现和解决脑灌注不良。虽然我们已经介绍了近红外光谱（NIRS）监测的目的，检测脑灌注不良，没有标准一直可用。我们通过检查额叶局部氧饱和度（rSO（2））持续下降与神经系统事件发生的关系来寻找这一标准。方法：对59例主动脉手术患者行选择性脑灌注（SCP）检查。在整个手术过程中监测rSO（2），并确定每例患者rSO（2）下降至55%以下和60%以下的持续时间。比较发生和未发生神经系统事件的患者rSO（2）下降的持续时间和其他手术相关参数。结果：共有16例（27.1%）出现神经系统事件。在这16例病例中，6例记录了新发脑梗死。发生神经系统事件的16例患者的手术时间和rSO（2）下降的持续时间显著长于未发生事件的43例患者（手术时间：546.8 vs 448.1 min，P = 0.0064; rSO（2）低于60%：141.2 vs 49.8 min，P = 0.0032; rSO（2）低于55%：两组患者年龄、转流时间、主动脉阻断时间、SCP时间、停循环时间差异无统计学意义（P > 0. 05）。在3例提示低灌注的梗死患者中，观察到rSO（2）持续下降，而在其余3例提示栓塞的梗死患者中，rSO（2）不显著。在53例无梗死的患者中，rSO（2）持续下降低于55%超过5分钟的患者更容易发生一过性神经系统事件（44.4% vs 5.7%，P = 0.0014）。结论：主动脉手术期间rSO（2）的持续下降与术后神经系统事件的发生密切相关。我们建议应立即解决rSO（2）下降到55%以下的恢复问题。然而，近红外光谱的使用是有限的检测栓塞事件或低灌注在基底区。(C)2004 Elsevier B.V.保留所有权利。
Objective: To minimize the neurological complications following cardiovascular surgery, it is essential to prevent an occurrence of cerebrovascular embolism and to detect and solve cerebral malperfusion without delay in the operating theater. Although we have introduced near-infrared spectroscopy (NIRS) monitoring for the purpose of detecting cerebral malperfusion, no criterion has been available. We searched for this criterion by examining the relationship of sustained drop in the regional oxygen saturation (rSO(2)) of the frontal lobes to the occurrence of neurological events. Methods: The 59 consecutive patients undergoing aortic surgery with selective cerebral perfusion (SCP) were examined. The rSO(2) was monitored throughout the surgery and the durations of drops in rSO(2) to below 55% and those below 60% were determined for each patient. The durations of rSO(2) drop and other surgery-related parameters were compared between the patients in whom neurological events occurred and those without such events. Results: A total of 16 cases (27.1%) presented with neurological events. Newly developed cerebral infarction was documented in 6 of these 16 cases. Operation time and the durations for which rSO(2) dropped were significantly longer for the 16 patients with neurological events than for the 43 patients without events (Op time: 546.8 versus 448.1 min, P = 0.0064; rSO(2) below 60%: 141.2 versus 49.8 min, P = 0.0032; rSO(2) below 55%: 66.6 versus 10.6 min, P = 0.0011), while there was no significant difference in age, bypass time, aortic clamping time, SCP time, and circulatory arrest time between the two groups. In the 3 patients with infarcts suggestive to hypoperfusion, sustained decrease in rSO(2) was observed, while it was not significant in the remaining 3 patients with infarcts suggestive to embolism. Among the 53 patients without infarction, transient neurological events occurred more frequently in patients with sustained drop in rSO(2) below 55% for over 5 min (44.4% versus 5.7%, P = 0.0014). Conclusions: A sustained drop in rSO(2) during aortic surgery is closely related to the occurrence of neurological events following surgery. We recommend that recovery of drop in rSO(2) below 55% should be addressed without delay. However, use of NIRS is limited for detecting embolic events or hypoperfusion in the basilar region. (C) 2004 Elsevier B.V. All rights reserved.