近红外分光仪在小儿体外循环中的应用

Application of Near-Infrared Spectroscopy in Pediatric Cardiopulmonary Bypass

目的探讨小儿体外循环中,近红外分光仪(NIRS)在监测脑氧合功能方面的价值。方法心内直视手术病人24例,随机平均分为两组:中度低温体外循环(MHCPB)组(n=12)和深低温停循环(DHCA)组(n=12),NIRS连续监测脑组织氧合血红蛋白(cere-HbO2),CPB开始、降温末、复温末以及术后6小时四个时点分别测定颈静脉球血测定乳酸值(Lact)和特异性神经源性烯醇化酶(NSE),术前、术后脑电图(EEG)检查各一次,并进行相关分析。结果MHCPB组中,无脑电图异常,cere-HbO2指标变化不大,与生化指标也无显著相关;DHCA组中,两例患儿术后出现异常脑电图,cere-HbO2指标在停循环开始便显著下降,下降幅度和持续时间与复温末Lact及NSE值显著相关。结论DHCA中,cere-HbO2与反映脑损害的其它指标显著相关,NIRS是一种崭新的,无创的脑氧合监测方法。

Objective To evaluate the use of near- infrared spectroscopy for monitoring cerebral oxygenation in pediatric cardiopulmonary bypass. Method Twenty- four patients underwent open- heart surgery were assigned randomly in two groups： moderate hypothermia cardiopulmonary bypass and deep hypothermia circulatory arres, with continuous monitoring by near- infrared spectroscopy. We measured electreencephalography, biochemical indicators such as neuron - specific enolase and lactate at four time point： CPB begining, end of cooling, end of rewarming, and 6 hours post operation, we checked EEG before and one week post operation, and performed correlation analyses. Results For group MHCPB, No infant showed EEG abnormality, cere- HbO2 have no significant change, and showed no correlation with biochemical indicators. For DHCA group, two infants were found EEG background abnormality post operation, cere - HbO2 dropped sharply with the onset of circulatory arrest, the range of declined and the duration of nadir were significant correlated with the values of lactate and NSE at the end of rewarming. Condusion Cere - HbO2 showed strong correlation with other cerebral function assessment for deep hypothermia circulatory arrest. NIRS is a new, non- invasive method to measure cerebral oxygen.