顺行性脑灌注联合脑氧饱和度监测在深低温停循环期间的脑保护作用

Brain protection with selective antegrade cerebral perfusion and near-infrared spectroscopy cerebral oxygen saturation monitoring during deep hypothermic circulatory arrest

目的探讨选择性顺行性脑灌注(SACP)联合脑氧饱和度监测在深低温停循环(DHCA)期间的脑保护作用。方法收集、分析2012年12月至2014年5月在我院行DHCA大血管手术13例(男9例,女4例)的病历资料,5例行单纯DHCA,8例行DHCA+SACP,13例手术期间均实时监测患者脑氧饱和度、连续血气分析,体外循环前脑氧饱和度值为基础值。结果 13例DHCA患者均存活,术后无神经功能障碍。单纯DHCA组脑氧饱和度随停循环时间延长下降,停循环期间脑氧饱和度最低值(45.4%±2.1%)显著低于基础值(60.1%±1.9%)(t=11.6,P<0.001)。DHCA+SACP组停循环期间脑氧饱和度水平稳定。停循环期间脑氧饱和度最低值(59.3%±3.2%)与基础值(62.1%±2.4%)无统计学差异(t=1.98,P>0.05)。结论脑氧饱和度监测可实时反映停循环期间脑功能状况,SACP联合脑氧饱和度监测可在DHCA期间提供充分脑保护,减少术后神经功能障碍发生。

Objective To provide a clinical basis for protective measures that may decrease injury of the central nervous system by using combined selective antegrade cerebral perfusion （ SACP ） and near-infrared spectroscopy cerebral oxygen saturation （NIRS） monitoring during deep hypothermic circulatory arrest （ DHCA）. Methods Between December 2012 and May 2014,thirteen cases（nine males,four females）underwent aortic arch replacement surgery with DHCA were retrospectively analyzed .Five cases received simple DHCA, eight cases received DHCA ＋SACP.Patients were attached to NIRS for rSO 2 monitoring and CDI500 for continuous blood gas monitoring.Cerebral oxygen saturation before cardiopulmonary bypass （CPB）were baseline values.Results In this retrospective case series,all patients survived,and there were no postoperative neurologic complications .In the simple DHCA group, cerebral oxygen saturation decreased with prolonged circulatory arrest , the lowest oxygen saturation value during circulatory arrest were significantly lower than baseline value before CPB （45.4% ±2.1%vs.60.1% ±1.9%,t =11.6,P 〈0.001）.In the DHCA ＋SACP group,cerebral oxygen saturation remained stable during circulatory arrest,there were no difference between the lowest oxygen saturation value during circulatory arrest and baseline value before CPB （59.3% ±3.2% vs.62.1% ±2.4%,t =1.98,P 〉0.05）.Conclusions NIRS can be effective in monitoring brain function during DHCA,SACP combined NIRS can provide adequate protection for the brain,and reduce the postoperative neurological dysfunction .