The role of diffuse correlation spectroscopy and frequency-domain near-infrared spectroscopy in monitoring cerebral hemodynamics during hypothermic circulatory arrests.
The role of diffuse correlation spectroscopy and frequency-domain near-infrared spectroscopy in monitoring cerebral hemodynamics during hypothermic circulatory arrests.
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DOI：
10.1016/j.xjtc.2021.01.023
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发表时间：
2021-06
期刊：
影响因子：
1.6
通讯作者：
Qu JZ
中科院分区：
文献类型：
--
作者：
Zavriyev AI;Kaya K;Farzam P;Farzam PY;Sunwoo J;Jassar AS;Sundt TM;Carp SA;Franceschini MA;Qu JZ
手术期间实时无创监测脑血流（CBF）是降低与需要低温停循环（HCA）的成人心脏手术相关的死亡率的关键。我们探索了一种方法来监测脑血流在不同的脑保护技术，使用扩散相关光谱（DCS），一种非侵入性的光学技术，结合频域近红外光谱（FDNIRS），也提供了一个衡量氧代谢。我们使用DCS结合FDNIRS同时测量血红蛋白氧饱和度（SO2），脑血流量指数（CBFi）和脑氧代谢率指数（CMRO 2 i）在12例接受心脏手术的HCA患者。我们的测量结果显示，在HCA逆行脑灌注过程中，输送到大脑皮层的血液量可以忽略不计，与仅HCA的病例无法区分（中位CBFi分别下降93%和95%），随后SO2也出现类似下降（平均每分钟分别下降0.6 ± 0.1%和0.9 ± 0.2%）; CBFi和SO 2主要通过顺行脑灌注维持; CMRO 2 i与温度的关系式为CMRO 2 i = 0.052e ~（0.079）T。FDNIRS-DCS能够通过干预检测CBFi、SO2和CMRO 2 i的变化，可以成为HCA期间优化脑保护的有价值的工具。心脏手术期间的实时无创脑血流监测有助于优化神经保护措施，从而降低与低温循环停搏（HCA）相关的神经损伤率。我们使用频域近红外光谱和弥散相关光谱（FDNIRS-DCS）联合测量12例接受HCA的成人（4例单纯HCA，3例逆行脑灌注[RCP]，5例顺行脑灌注[ACP]）的血红蛋白氧饱和度（SO2），脑血流指数（CBFi）和脑氧代谢率（CMRO 2 i）。我们从医院血氧仪（INVOS）、平均动脉血压（MAP）和鼻咽温度共同采集局部氧饱和度（rSO 2）。我们的测量结果显示，在使用RCP的HCA期间，CBFi下降到几乎为零，并且在循环重新开始时超过基线，类似于仅HCA期间发现的CBFi行为。由于低灌注，使用RCP和HCA时，HCA期间SO2减少;相比之下，使用ACP时CBFi和SO2大部分保持不变。
Real-time noninvasive monitoring of cerebral blood flow (CBF) during surgery is key to reducing mortality rates associated with adult cardiac surgeries requiring hypothermic circulatory arrest (HCA). We explored a method to monitor cerebral blood flow during different brain protection techniques using diffuse correlation spectroscopy (DCS), a noninvasive optical technique which, combined with frequency-domain near-infrared spectroscopy (FDNIRS), also provides a measure of oxygen metabolism. We used DCS in combination with FDNIRS to simultaneously measure hemoglobin oxygen saturation (SO2), an index of cerebral blood flow (CBFi), and an index of cerebral metabolic rate of oxygen (CMRO2i) in 12 patients undergoing cardiac surgery with HCA. Our measurements revealed that a negligible amount of blood is delivered to the cerebral cortex during HCA with retrograde cerebral perfusion, indistinguishable from HCA-only cases (median CBFi drops of 93% and 95%, respectively) with consequent similar decreases in SO2 (mean decrease of 0.6 ± 0.1% and 0.9 ± 0.2% per minute, respectively); CBFi and SO2 are mostly maintained with antegrade cerebral perfusion; the relationship of CMRO2i to temperature is given by CMRO2i = 0.052e0.079T. FDNIRS-DCS is able to detect changes in CBFi, SO2, and CMRO2i with intervention and can become a valuable tool for optimizing cerebral protection during HCA. Real-time noninvasive cerebral blood flow monitoring during cardiac surgery could help optimize neuroprotective measures and hence decrease rates of neurologic injury associated with hypothermic circulatory arrests (HCAs). We used combined frequency-domain near-infrared spectroscopy and diffuse correlation spectroscopy (FDNIRS-DCS) to measure hemoglobin oxygen saturation (SO2), cerebral blood flow index (CBFi), and cerebral metabolic rate of oxygen (CMRO2i) in 12 adults undergoing HCA (4 HCA-only, 3 retrograde cerebral perfusion [RCP], 5 antegrade cerebral perfusion [ACP]). We coacquired regional oxygen saturation (rSO2) from a hospital oximeter (INVOS), mean arterial blood pressure (MAP), and nasopharyngeal temperature. Our measurements revealed that during HCA with RCP CBFi drops to almost zero and overshoots above baseline when circulation is restarted, similar to the CBFi behavior found during HCA-only. As a consequence of the low perfusion, with RCP and HCA-only SO2 decreases during HCA; in contrast, both CBFi and SO2 are mostly maintained with ACP.
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