JUGULAR BULB SATURATION AND COGNITIVE DYSFUNCTION AFTER CARDIOPULMONARY BYPASS
JUGULAR BULB SATURATION AND COGNITIVE DYSFUNCTION AFTER CARDIOPULMONARY BYPASS
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DOI：
10.1016/0003-4975(94)91666-7
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发表时间：
1994-12-01
影响因子：
4.6
通讯作者：
REVES, JG
中科院分区：
文献类型：
--
作者：
CROUGHWELL, ND;NEWMAN, MF;REVES, JG
体外循环期间脑氧合不足可能导致心脏手术患者术后认知功能障碍。对255例心脏手术前和出院前的患者进行了心理测试。术后损害定义为20%的测试中下降超过一个标准差。与术后认知功能障碍显著相关的变量（p < 0.05）是基线心理测量评分、最大动-静脉血氧差和受教育年限。如果颈静脉球血红蛋白饱和度代替模型中的动-静脉氧差，则颈静脉球血红蛋白饱和度是显著的。与常温下颈静脉球饱和度相关的因素有脑耗氧代谢率（r = -0.6; p < 0.0005）、脑血流量（r = 0.4; p < 0.0005）、氧供给（r = 0.4; p < 0.0005）和平均动脉压（r = 0.15; p < 0.05）。三个措施显着相关的去饱和度在常温和低温，以及：更大的脑氧提取，更大的动脉-静脉氧差，和较低的脑血流量比动脉-静脉氧差。我们的结论是，17%至23%的人在体外循环期间发生脑静脉去饱和，并与术后认知测试表现受损有关。
Inadequate cerebral oxygenation during cardiopulmonary bypass may lead to postoperative cognitive dysfunction in patients undergoing cardiac operations. A psychological test battery was administered to 255 patients before cardiac operation and just before hospital discharge. Postoperative impairment was defined as a decline of more than one standard deviation in 20% of tests. Variables significantly (p < 0.05) associated with postoperative cognitive impairment are baseline psychometric scores, largest arterial-venous oxygen difference, and years of education. Jugular bulb hemoglobin saturation is significant if it replaces arterial-venous oxygen difference in the model. Factors correlated with jugular bulb saturation at normothermia were cerebral metabolic rate of oxygen consumption (r = -0.6; p < 0.0005), cerebral blood now (r = 0.4; p < 0.0005), oxygen delivery (r = 0.4; p < 0.0005), and mean arterial pressure (r = 0.15; p < 0.05). Three measures were significantly related to desaturation at normothermia and at hypothermia as well: greater cerebral oxygen extraction, greater arterial-venous oxygen difference, and lower ratio of cerebral blood now to arterial-venous oxygen difference. We conclude that cerebral venous desaturation occurs during cardiopulmonary bypass in 17% to 23% of people and is associated with impaired postoperative cognitive test performance.