Retrospective evaluation of the effect of carotid artery stenosis on cerebral oxygen saturation during off-pump coronary artery bypasses grafting in adult patients.
Retrospective evaluation of the effect of carotid artery stenosis on cerebral oxygen saturation during off-pump coronary artery bypasses grafting in adult patients.
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DOI：
10.1186/s12871-015-0164-z
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发表时间：
2015-12-15
影响因子：
2.2
通讯作者：
Shimoyama M
中科院分区：
文献类型：
--
作者：
Toyama S;Matsuoka K;Tagaito Y;Shimoyama M
目前尚不清楚接受非体外循环冠状动脉旁路移植术（CABG）的颈动脉狭窄（CAS）患者的脑氧合是否与非CAS患者不同。因此，回顾性评价了成人患者非体外循环CABG期间CAS ≥ 50%对脑氧合的影响。入选了11例CAS ≥ 50%的患者和14例无CAS ≥ 50%的患者。局部脑组织氧饱和度（rSO 2）使用近红外光谱定量。收集特定点的平均动脉压、心脏指数、中心静脉压（CVP）和rSO 2，并使用重复方差分析检测每个参数的显著变化。通过单因素方差分析分析吻合期间的平均rSO 2和最小rSO 2。使用多元逻辑回归分析估计脑去饱和（rSO 2较术前值降低≥ 10%）的比值比（OR）和95%置信区间（CI）。2例术前接受完全颈动脉支架植入术的CAS ≥ 50%的患者从分析中排除。在有和没有CAS的患者中，在吻合术期间观察到rSO 2和心脏指数降低以及CVP增加。在CAS ≥ 50%的患者中，rSO 2相对于术前值的平均（SD）最大降幅为左侧9.2（12.7）%和右侧8.1（11.7）%，在无CAS ≥ 50%的患者中，左侧13.5（11.3）%和右侧16.1（9.8）%（p = 0.316）。在CAS ≥ 50%和无CAS ≥ 50%的患者中均未发现神经系统并发症。在多元逻辑回归分析中，CAS ≥ 50%与脑去饱和风险增加无关（OR 0.160，95% CI 0.036-0.707，p = 0.016），rSO 2随心脏指数< 2.0 l/min/m2降低而降低（OR 3.287，95% CI 2.218-5.076，p < 0.001）。CAS ≥ 50%不是非体外循环CABG术中脑氧饱和度降低的独立危险因素.我们的研究结果表明，在CAS ≥ 50%和无CAS ≥ 50%的患者中，维持心输出量可以防止脑氧合降低。
It is unknown whether cerebral oxygenation in patients with carotid artery stenosis (CAS) undergoing off-pump coronary artery bypass grafting (CABG) differs from that in patients without CAS. Thus, the effect of the presence of CAS ≥ 50 % on cerebral oxygenation during off-pump CABG in adult patients was evaluated retrospectively. Eleven patients with CAS ≥ 50 % and 14 patients without CAS ≥ 50 % were enrolled. Regional cerebral tissue oxygen saturation (rSO2) was quantified using near-infrared spectroscopy. Mean arterial pressure, cardiac index, central venous pressure (CVP), and rSO2 at specific points were collected, and significant changes in each parameter were detected using repeated analysis of variance. Mean rSO2 and minimum rSO2 during anastomosis were analyzed by one-way analysis of variance. Multiple logistic regression analysis was used to estimate the odds ratio (OR) with 95 % confidence interval (CI) for cerebral desaturation (a decrease in rSO2 ≥ 10 % from preoperative value). Two patients with CAS ≥ 50 % who received complete carotid artery stenting preoperatively were excluded from the analyses. In both patients with and without CAS, a decrease in rSO2 and cardiac index and an increase in CVP were observed during anastomosis. Mean (SD) maximum decrease in rSO2 from preoperative value was 9.2 (12.7) % on the left side and 8.1 (11.7) % on the right side in patients with CAS ≥ 50 %, and 13.5 (11.3) % on the left side and 16.1 (9.8) % on the right side in patients without CAS ≥ 50 % (p = 0.316). Neurological complications were not identified in both patients with and without CAS ≥ 50 %. In multiple logistic regression analysis, CAS ≥ 50 % was not associated with an increased risk of cerebral desaturation (OR 0.160, 95 % CI 0.036–0.707, p = 0.016), and rSO2 decreased with decreasing cardiac index < 2.0 l/min/m2 (OR 3.287, 95 % CI 2.218–5.076, p < 0.001). CAS ≥ 50 % was not an independent risk factor of cerebral desaturation during off-pump CABG. Our results suggest that maintaining cardiac output can prevent a decrease in cerebral oxygenation in both patients with and without CAS ≥ 50 %.