烟雾病血管搭桥术中脑氧供需平衡监测

The monitoring of cerebral oxygen balance during superficial temporal arterymiddle cerebral artery bypass surgery for patients with Moyamoya disease

目的探讨局部脑氧饱和度（rSO2）监测在烟雾病患者行脑血管搭桥术中反映脑氧供需平衡的临床应用价值。方法17例缺血型烟雾病患者，ASAⅠ-Ⅱ级，Suzuki≥Ⅲ级，在丙泊酚一瑞芬太尼麻醉下行脑血管搭桥手术。术中常规监测动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（PetCO2）、脑电双频指数（BIS）、体温（T）、局部脑氧饱和度（rSO2）及记录动静脉血气分析数据，并根据Fick原理计算脑动脉-颈内静脉球氧含量差（Ca—vDO2）。术中维持BIS在40～50，按随机顺序调节呼吸参数，分别将PaCO2控制在30、40、50mmHg水平，稳定10rain后记录上述监测指标。结果术中MAP、HR、Hb、BIS、T、PaO2无显著变化。rSO2和颈静脉球氧饱和度（SjvO2）随着PaCO2的增减而升高或下降（P〈0．01）；Ca—vDO2随着PaCO2的增减而降低或升高（P〈0．05）；rSO2与SjvO2呈明显正相关（r=0．745，P=0．000），而rS02与Ca—vD02呈显著的负相关（r=-0．64，P=0．000）。结论烟雾病患者行脑血管搭桥术中，rSO2监测能够及时准确反映额叶脑血流及氧供需平衡的变化，预防术中脑缺血等不良事件的发生。

Objective To investigate the value of regional cerebral oxygen saturation （rSO2 ） monitoring in clinical application for patients with Moyamoya disease during superficial temporal artery - middle cerebral （MT- MC） artery bypass surgery Methods 17 patients with ischemic - type Moyamoya disease, ASA Ⅰ - Ⅱ, Suzuki ≥ 3, were scheduled for MT - MC artery anastomosis undergoing propofol remifentanil anesthesia. Blood pressure （BP） , heart rate（HR） , pulse oxygen saturation（ SpO2 ） , endtidal carbon dioxide partial pressure （PetCO2 ）, body tempreture （T）, bispectral index （BIS） and rSO2 were monitored and the data of blood gas analysis was recorded intraoperatively. The arteriovenous oxygen difference （ Ca - vDO2 ） were calculated according to Fiek principle. BIS was maintained between 40 to 50 during surgery. All data were recorded at PaCO2 30, 40, 50 mmHg respectively. Results There were no significant differences in MAP, HR, Hb, BIS, T and PaO2 among different PaCO2. Jugular vein bulb oxygen saturation （SjvO2 ） and rSOEincreased and decreased along with PaCO2 up and down （ P 〈0. O1 ）, while Ca- vDO2 were reversed completely （P =0. 015）. There was significant positive correlation between SjvO2 and rSO2 （ r = 0. 745, P = O. 000） and negative correlation between Ca - vDO2 and rSO2 （ r = - 0. 64, P = 0. 000 ）. Conclusion Regional cerebral oxygen saturation monitoring provides the real -time and accurate information of CBF and cerebral oxygen balance in frontal lobe and prevents cerebral ischemic accident during MT - MC artery bypass surgery in patients with Moyamoya disease.