Near-Infrared Spectrophotometry of the Brain in Cardiovascular Surgery
Near-Infrared Spectrophotometry of the Brain in Cardiovascular Surgery
复制标题
心血管手术中大脑的近红外分光光度测定
DOI：
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
R. Jonas
中科院分区：
文献类型：
--
作者：
G. Nollert;T. Shin’oka;R. Jonas
神经心理和神经功能缺陷仍然是心脏手术后死亡和发病的主要原因，被认为是由栓塞和脑缺氧引起的。近红外分光光度法（NIRS）是一种有前途的无创监测脑氧合和血流动力学的方法。不同的设备提供有关含氧血红蛋白 (HbO2) 和脱氧血红蛋白 (Hb)、氧化细胞色素 aa3 (CytOx) 或局部氧饱和度 (rSO2) 变化的信息。 NIRS 已应用于成人和儿童心血管手术期间有或没有深低温停循环 (DHCA) 的患者。在大多数研究中，NIRS 检测到脑氧合的显着变化。 NIRS 测量受到脑氧代谢和手术管理的影响。然而，临床、实验和理论问题对体温过低和碱中毒期间血红蛋白饱和度（HbO2、Hb、rSO2 信号）的临床相关性提出了质疑，因为血红蛋白的氧亲和力增加，高饱和度可能仅仅反映了细胞内氧输送不足。相比之下，最近的实验证明了 CytOx 信号与 MRS 参数三磷酸核苷和磷酸肌酸之间存在高度相关性。组织学损伤与最低的CytOx值显着相关；在一项临床研究中，它预测了神经心理学结果受损。因此，CytOx 信号对未来的研究非常有意义。 NIRS 必须在大型患者研究中证明其在心脏手术期间一致诊断脑缺氧的能力，然后才能将此方法纳入常规临床实践。临界氧合裕度的绝对量化和定义将有助于实现这一目标。
Neuropsychological and neurological deficits are still major causes of mortality and morbidity after cardiac operations and are thought to be caused by embolism and cerebral hypoxia. Near-infrared spectrophotometry (NIRS) is a promising method for non-invasive monitoring of cerebral oxygenation and hemodynamics. Different devices provide information on changes of oxygenated (HbO2) and deoxygenated hemoglobin (Hb), oxidized cytochrome aa3 (CytOx) or regional oxygen saturation (rSO2). NIRS has been applied to patients during adult and pediatric cardiovascular surgery with and without deep hypothermic circulatory arrest (DHCA). In most of the studies, significant changes in cerebral oxygenation were detected by NIRS. NIRS measurements were influenced by the cerebral oxygen metabolism and the operative management. However, clinical, experimental, and theoretical issues raise doubts as to the clinical relevance of the hemoglobin saturation (HbO2, Hb, rSO2 signals) during hypothermia and alkalosis, because the oxygen affinity of hemoglobin increases and a high saturation might simply reflect the inadequate oxygen transport into cells. In contrast, recent experiments have proved a high correlation between the CytOx signal and the MRS parameters nucleoside triphosphate and phosphocreatine. Histological damage was significantly related to the lowest CytOx value; in a clinical study it predicted impaired neuropsychological outcome. Therefore, the CytOx signal is of great interest for future studies. NIRS must prove its ability to diagnose cerebral hypoxia consistently during cardiac surgery in a large patient study before this method is brought into routine clinical practice. Absolute quantification and definitions of critical oxygenation margins will be helpful for this goal.
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停循环前后的 pH 策略和脑能量学。
DOI：
10.1016/s0022-5223(95)70321-7
发表时间：
1995
期刊：
The Journal of thoracic and cardiovascular surgery.
影响因子：
--
作者：
Hiramatsu,T;Miura,T;Forbess,JM;DuPlessis,A;Aoki,M;Nomura,F;Holtzman,D;Jonas,RA
通讯作者：
Jonas,RA
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影响因子：
158.5
作者：
BELLINGER, DC;JONAS, RA;NEWBURGER, JW
通讯作者：
NEWBURGER, JW
用于确定组织氧合的时间和频率分辨光谱的定量。
影响因子：
2.9
作者：
Sevick,EM;Chance,B;Leigh,J;Nioka,S;Maris,M
通讯作者：
Maris,M
影响因子：
56.9
作者：
BENARON, DA;STEVENSON, DK
通讯作者：
STEVENSON, DK
影响因子：
3.7
作者：
David S. Smith
通讯作者：
David S. Smith