Monitoring cerebral blood flow pressure autoregulation in pediatric patients during cardiac surgery.
Monitoring cerebral blood flow pressure autoregulation in pediatric patients during cardiac surgery.
复制标题
DOI：
10.1161/strokeaha.109.575167
复制
发表时间：
2010-09
期刊：
影响因子：
8.3
通讯作者：
Easley RB
中科院分区：
文献类型：
--
作者：
Brady KM;Mytar JO;Lee JK;Cameron DE;Vricella LA;Thompson WR;Hogue CW;Easley RB
脑血流-压力自动调节的限度尚未充分确定儿科患者。平均动脉血压低于这些限制可能会导致心脏手术期间的脑损伤。这项初步研究的目的是评估一种新的方法，确定儿童患者的压力自动调节下限支持心肺转流。在接受心肺转流心脏手术以矫正先天性心脏缺陷的儿童（n=54）中进行了一项前瞻性、观察性初步研究。脑血氧指数（考克斯）计算为动脉血压慢波与近红外光谱测量的脑血氧之间的移动线性相关系数。每例患者的平均考克斯值按动脉血压排序，构建自动调节曲线。低血压与考克斯值升高相关（P<0.0001）。对于77%的患者，可以使用0.4的考克斯阈值确定压力自动调节下限的个体估计值。使用该方法的队列的压力自动调节的平均下限为42±7 mm Hg。这项在儿科患者中进行的考克斯监测的初步研究证明了心肺转流期间低血压与自动调节受损之间的相关性。考克斯可能有助于确定心肺转流期间脑自动调节的动脉血压依赖性极限。有神经系统结局的大型试验也适用。
The limits of cerebral blood flow-pressure autoregulation have not been adequately defined for pediatric patients. Mean arterial blood pressure below these limits might contribute to brain injury during cardiac surgery. The purpose of this pilot study was to assess a novel method of determining the lower limits of pressure autoregulation in pediatric patients supported with cardiopulmonary bypass. A prospective, observational pilot study was conducted in children (n=54) undergoing cardiac surgery with cardiopulmonary bypass for correction of congenital heart defects. Cerebral oximetry index (COx) was calculated as a moving, linear correlation coefficient between slow waves of arterial blood pressure and cerebral oximetry measured with near-infrared spectroscopy. An autoregulation curve was constructed for each patient with averaged COx values sorted by arterial blood pressure. Hypotension was associated with increased values of COx (P<0.0001). For 77% of patients, an individual estimate of lower limits of pressure autoregulation could be determined using a threshold COx value of 0.4. The mean lower limits of pressure autoregulation for the cohort using this method was 42±7 mm Hg. This pilot study of COx monitoring in pediatric patients demonstrates an association between hypotension during cardiopulmonary bypass and impairment of autoregulation. The COx may be useful to identify arterial blood pressure-dependent limits of cerebral autoregulation during cardiopulmonary bypass. Larger trials with neurological outcomes are indicated.