Real-Time Continuous Neuromonitoring Combines Transcranial Cerebral Doppler with Near-Infrared Spectroscopy Cerebral Oxygen Saturation During Total Aortic Arch Replacement Procedure: A Pilot Study
Real-Time Continuous Neuromonitoring Combines Transcranial Cerebral Doppler with Near-Infrared Spectroscopy Cerebral Oxygen Saturation During Total Aortic Arch Replacement Procedure: A Pilot Study
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DOI：
10.1097/mat.0b013e318241abd3
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发表时间：
2012-03-01
期刊：
影响因子：
4.2
通讯作者：
Long, Cun
中科院分区：
文献类型：
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作者：
Wang, Xiaohua;Ji, Bingyang;Long, Cun
本研究旨在应用经颅脑多普勒（TCD）和近红外光谱（NIRS）联合监测全主动脉弓置换术（TAAR）中大脑中动脉血流速度和局部脑氧饱和度（rSO（2））的变化，为临床采取保护措施减少中枢神经系统损伤提供依据。对12例成年患者行深低温停循环（DHCA）和选择性脑灌注（ASCP）治疗TAAR。麻醉诱导后将TCD探头置于颞窗，NIRS探头置于患者前额，采集围术期、术中和术后血流动力学参数，以及体外循环（CPB）期间的脑血流量（CBF）和rSO（2）。在该回顾性病例系列中，所有患者均存活，无术后神经系统并发症。平均动脉压与rSO（2）之间无显著相关性。大脑中动脉平均血流速度（VmMCA）与rSO（2）显著相关，主泵流量与rSO（2）显著相关。ASCP后，VmMCA、rSO（2）和静脉血氧饱和度显著低于ASCP前，但术后VmMCA和rSO（2）恢复至CPB前水平。停泵后ASCP流量与VmMCA、rSO（2）呈显著正相关。DHCA期间，当ASCP流量低于5 ml/kg/min时，TCD无法检测到MCA血流信号。ASCP流量在10 ml/kg/min以上时，MCA血流速度维持不变，rSO（2）> 45%。TCD和NIRS联合应用可有效监测DHCA联合ASCP术中的脑功能，为减少TAAR术中的脑损伤提供指导。ASAIO Journal 2012; 58：122-126.
The purpose of this investigation was to use combined transcranial cerebral Doppler (TCD) and near-infrared spectroscopy cerebral oxygen saturation (NIRS) during total aortic arch replacement (TAAR) to monitor middle cerebral artery blood flow velocity and regional cerebral oximetry (rSO(2)) changes to provide a clinical basis for protective measures that may decrease injury of the central nervous system. Consecutive 12 adult patients underwent deep hypothermic circulatory arrest (DHCA) and antegrade selective cerebral perfusion (ASCP) during TAAR. A TCD probe was placed at the temporal windows after induction of anesthesia and the NIRS probe placed on the forehead of patients to collect perioperative, intraoperative, and postoperative hemodynamic parameters, and cerebral blood flow (CBF) and rSO(2) during cardiopulmonary bypass (CPB). In this retrospective case series, all patients survived, and there were no postoperative neurologic complications. There was no significant correlation between the mean arterial pressure and rSO(2). The middle cerebral artery mean velocity (VmMCA) and rSO(2) were significantly correlated, and main pump flow significantly correlated with rSO(2). After ASCP, VmMCA, rSO(2), and venous oxygen saturation were significantly lower than before ASCP, but VmMCA and rSO(2) returned to pre-CPB levels postoperatively. After off pump, the flow of ASCP showed a significant positive correlation with VmMCA and rSO(2). During DHCA when ASCP flow was lower than 5 ml/kg/min, TCD could not detect the MCA blood flow signal. When the flow of ASCP was above keeping around 10 ml/kg/min, MCA CBF velocity was maintained and rSO(2) > 45%. The combination of TCD and NIRS can be effective in monitoring brain function during DHCA with ASCP and may provide a guide for decreasing brain injury during the TAAR procedure. ASAIO Journal 2012; 58:122-126.