有无合并颅脑血管狭窄的冠心病者体外循环冠脉搭桥手术间脑氧饱和度的差异

Comparison of Cerebral oxygen saturation during coronary artery bypass grafting between CAD patients with cerebral artery stenosis and CAD patients without cerebral artery stenosis

目的探讨有无合并颅脑血管狭窄的冠心病患者,体外循环冠脉搭桥手术期间脑氧饱和度的差异。方法24例冠心病冠脉搭桥术患者,根据术前颅脑血管超声筛查结果分为合并颅脑血管狭窄组和无颅脑血管狭窄组,ASAⅡ~Ⅲ级,术中常规监测动脉压（MAP）、心率（HR）、脉搏血氧饱和度（Sp O2）、呼气末二氧化碳分压（Pet CO2）、脑电双频指数（BIS）、体温（T）、氧饱和度（Sct O2）。观察组内和组间各时间点脑氧饱和度变化趋势和差异。结果体外循环期间,Sct O2明显下降（P〈0.05）,合并颅脑血管狭窄组患者脑氧饱和度数值低于无颅脑血管狭窄的患者,两组患者术后均无认知功能障碍和严重神经系统并发症发生。结论在体外循环冠脉搭桥手术期间,冠心病患者存在不同程度的脑氧饱和度下降,合并颅脑血管狭窄的患者,脑氧饱和度下降持续时间更长,下降程度更为严重,需要更加积极谨慎的管理,预防神经系统不良事件的发生。

Objective To compare the value of cerebral tissue oxygen saturation（Sct O2） of patients with or without cerebral artery stenosis during coronary artery bypass grafting（CABG）. Methods Twenty-four patients with coronary artery disease, ASA Ⅲ-Ⅲ, who were scheduled for CABG, were divided to two groups based whether they had cerebral artery stenosis or not. Blood pressure（BP）, heart rate（ HR）, pulse oxygen saturation（Sp O2）, end-tidal carbon dioxide partial pressure（Pet CO2）, body tempreture（T）, bispectral index（BIS） and Sct O2 were monitored and recorded intraoperatively.The changes and the differences of Sct O2 in both groups were observed. Results During cardiopulmonary bypass, Sct O2 was significantly decreased（P 0.05）, Sct O2 of patients with cerebral artery stenosis was significantly lower than that of patients without cerebral artery stenosis. There were no POCD or neurological complications after operation. Conclusion During coronary artery bypass surgery, decrease of Sct O2 varies. For patients with cerebral artery stenosis, cerebral oxygen saturation decrease continuously for a longer time, the decrease is more serious and need more active and careful management than patients without cerebral artery stenosis in order to prevent the occurrence of neurological adverse events.