成人中度低温停循环手术中不同选择性脑灌注流量对脑氧饱和度的影响

The effect of moderate hypothermic lower body circulatory arrest with different antegrade selective cerebral perfusion on cerebral oxygen saturations

目的应用近红外光谱(NIRS)监测仪连续监测中度低温停循环不同选择性脑灌注流量下的脑氧饱和度变化,为探讨合适的大脑灌注流量提供临床依据。方法选择Stanfard A型夹层动脉瘤患者40例,根据术中不同的脑灌注流量分为5ml·kg-1·min-1低流量组(D组)和10ml·kg-1·min-1高流量组(G组),每组20例。将NIRS的探头置于患者的额头,分别记录麻醉诱导后(T1)、心脏停跳时(T2)、选择性脑灌注3min时(T3)、恢复下半身循环3min时(T4)和停体外循环后5min(T5)时记录双侧局部大脑氧饱和度(rSO2),并测定患者围术期静脉血乳酸含量及术后恢复情况。结果所有患者无死亡和术后严重神经系统并发症发生,D组中1例患者术后出现轻度神经系统功能异常。两组患者各时点rSO2变化差异无统计学意义。两组患者的阻断时间、选择性脑灌注时间、转机时间差异均无统计学意义。两组患者各时间点乳酸水平差异亦无统计学意义。两组患者机械通气时间、监护室停留时间、术后12h引流量、术后住院时间差异均无统计学意义。结论成人中度低温停循环选择性脑灌注时,在一定时间内,5ml·kg-1·min-1和10ml·kg-1·min-1灌注流量时rSO2均在可接受的范围内,两种大脑灌注流量均可以满足临床需要。

Objective This study was to evaluate the effect of moderate hypothermic lower body circulatory arrest with two different antegrade selective cerebral perfusions（ASCP）on cerebral oxygen saturations in total aortic arch replacement procedure by near-infrared spectroscopy（NIRS）.Methods Forty adult patients undergoing total aortic arch replacement with moderate hypothermic circulatory arrest and ASCP were divided into the low flow group（group D,5ml·kg^-1·min^-1,n=20）and high flow group（group G,10ml·kg^-1·min^-1,n=20）.We monitored perioperative cerebral oxygen saturation at five different time period：after anesthetic induction（T1）,aortic-cross clamping（T2）,3min after ASCP（T3）,3min after resume systemic circulation（T4）,and 5min after termination of cardiopulmonary bypass（T5）.The concentration of plasma lactate in two group were detected at five different time points.Results There was no severe postoperative neurological complications or deaths.One patient suffered postoperative temporary neurologic dysfunction in the low flow group.There were no significant differences in duration of aortic-cross clamping,ASCP,and cardiopulmonary bypass between two groups.There was no significant difference in lactate levels between two groups at each time point.There were no significant differences in mechanical ventilation time,length of ICU stay,and postoperative hospital stay between two gruops.Conclusion In a certain period of time,the moderate hypothermic circulatory arrest combined with low flow（5ml·kg^-1·min^-1）or high flow（10ml·kg^-1·min^-1）antegrade cerebral perfusion represents might be an effective cerebral protective strategy in patients undergoing total aorta arch replacement.