近红外光谱联合脑电双频谱指数监测在深低温停循环手术脑氧平衡监测中的应用

Application of near-infrared spectroscopy and bispectral index in monitoring of cerebral oxygen balance during surgery with deep hypothermic circulatory arrest

目的以近红外光谱(NIRS)联合脑电双频谱指数(BIS)监测深低温停循环(DHCA)手术中脑氧平衡状况,分析监测指标的相关性。方法选取12例接受DHCA主动脉弓手术的患者,记录麻醉前(T0)、麻醉后30 min(T1)、主动脉阻断心脏停跳后(T2)、停循环5 min(T3)、停循环30 min(T4)、循环恢复后10 min(T5)、心脏复跳(T6)、脱离体外循环后10 min(T7)、脱离体外循环后30 min(T8)和术毕(T9)时的BIS、NIRS监测指标脑组织氧合指数(TOI)、平均动脉压(MAP)以及T1～T9时点的混合静脉血氧饱和度(SvO2)等指标,观察术后患者意识恢复状况和神经系统并发症发生情况;分析TOI与MAP、BIS、SvO2的相关性。结果 12例患者中,8例患者麻醉期间BIS为20～50,TOI为55%～75%,停循环期间BIS为0,TOI>58%,术后次日清醒;2例术中出血较多患者TOI<55%的时间>30 min,术后5 d未醒;1例TOI<55%但时间<10 min的患者术后次日清醒时有明显躁动,镇静治疗后延迟1 d清醒;另1例患者疑为外科因素于术后4 h死亡。相关性分析显示,TOI与MAP、BIS无显著线性相关,但与SvO2呈显著正相关(r=0.581 9,P<0.05)。结论近红外脑氧联合BIS监测可用于DHCA手术脑氧平衡动态监测可综合判断术中脑保护效果;TOI与SvO2呈显著正相关。

Objective To investigate the application of near-infrared spectroscopy and bispectral index(BIS) in monitoring of cerebral oxygen balance during surgery with deep hypothermic circulatory arrest(DHCA). Methods Twelve patients undergoing aortic reconstructive surgery with DHCA were included in this study.BIS,tissue oxygenation index(TOI) and mean arterial pressure(MAP) were recorded before anesthesia(T0),30 min after anesthesia(T1),after aortic occlusion and cardiac arrest(T2),5 min after circulatory arrest(T3),30 min after circulatory arrest(T4),10 min after circulatory restoration(T5),cardiac rebeating(T6),10 min after extracorporeal circulation withdrawl(T7),30 min after extracorporeal circulation withdrawl(T8) and at the end of operation(T9),mixed venous oxygen saturation(SvO2)was detected at the time points of T1 to T9,and postoperative consciousness state was observed.The relationship between TOI and MAP,BIS and SvO2 was analysed. Results In 8 of all the 12 patients,BIS varied from 20 to 50 and TOI changed from 55% to 75% during anesthesia,and BIS was 0 and TOI maintained above 58% during circulatory arrest.All these 8 patients came to consciousness on the first day after surgery.Another 2 patients who experienced relative massive hemorrhage and TOI lower than 55% for more than 30 min during operation did not regain consciousness 5 d after operation.One patient with a history of TOI less than 55%(for less than 10 min) was re-sedated due to restlessness on the first day after operation,and came to consciousness on the following day.The other patient died 4 h after operation.Correlation analysis revealed that TOI had no linear correlation with MAP and BIS,and TOI was significantly positively related to SvO2(r=0.581 9,P<0.05). Conclusion Near-infrared spectroscopy combined with BIS can be used for dynamic monitoring of cerebral oxygen balance during surgery with DHCA and comprehensive evaluation of cerebral protection during operation,and TOI may be significantly positively related to SvO2.