Optimizing intraoperative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients
Optimizing intraoperative cerebral oxygen delivery using noninvasive cerebral oximetry decreases the incidence of stroke for cardiac surgical patients
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DOI：
10.1532/hsf98.20041062
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发表时间：
2004-01-01
影响因子：
0.6
通讯作者：
Trace, C
中科院分区：
文献类型：
--
作者：
Goldman, S;Sutter, F;Trace, C
背景资料：最近的一项研究表明，近75%的冠状动脉血运重建术后中风发生在术前被归类为低至中等风险的患者中。因此，尽管使用了风险分类，但大多数中风都可能发生在意料之外的时候。我们假设，通过使用非侵入性脑血氧饱和度优化脑氧输送变量可以减少中风的发病率。方法：脑血氧饱和度是由所有外科医生使用，以监测脑氧饱和度在所有心脏手术患者从2002年1月1日，直到2003年6月30日（n=1034，18个月，治疗组）。在手术过程中，通过修改氧输送和消耗变量来优化脑氧输送，以维持血氧饱和度值处于或接近患者的诱导前基线。根据胸外科医师协会的指南定义卒中。在脑氧饱和度纳入前，将治疗组的卒中发生率与2000年7月1日至2001年12月31日期间接受心脏手术的患者（n=1245; 18个月，对照组）的卒中发生率进行比较。与对照组相比，研究组中纽约心脏协会（NYHA）III级和IV级的患者明显更多，并且研究组中的患者总体病情更重。尽管存在这种差异，研究组总体上永久性卒中较少（10例[0.97%]对25例[2.5%]; P
Background: A recent study demonstrated that almost 75% of strokes after coronary artery revascularization surgery occur in patients classified preoperatively as low to medium risk. Thus, despite the use of risk classification, most strokes can occur when not expected. We hypothesized that optimization of cerebral oxygen delivery variables by using noninvasive cerebral oximetry could reduce the incidence of stroke.Methods: Cerebral oximetry was used by all surgeons to monitor cerebral oxygen saturation in all cardiac surgery patients from January 1, 2002, until June 30, 2003 (n=1034; 18 months, treatment group). Cerebral oxygen delivery was optimized during surgery by modifying oxygen delivery and consumption variables to maintain oximetry values at or near the patient's preinduction baseline. Stroke was defined according to guidelines of the Society of Thoracic Surgeons. The incidence of stroke in the treatment group was compared with that for patients who underwent cardiac surgery between July 1, 2000, and December 31, 2001, (n=1245; 18 months, control group) before cerebral oximetry was incorporated.Results: Age and sex distribution were similar in the 2 groups. The study group had significantly more patients in New York Heart Association (NYHA) classes III and IV than the control group, and patients in the study group were sicker overall. Despite this difference, the study group overall had fewer permanent strokes (10[0.97%] versus 25 [2.5%]; P