近红外光谱仪监测成人主动脉弓部术中脑组织氧饱和度与中枢神经系统预后的相关性探索

The correlation between regional cerebral oxygen saturation and central postoperative neurological prognosis monitoring with near-infrared spectroscopy during adults aortic arch surgery

目的:探讨成人主动脉弓部术中脑组织氧饱和度与术后神经系统预后的相关性。方法:连续收集北京安贞医院2018年7月至2018年10月,应用中低温停循环行主动脉弓部替换手术的患者65例。术中以近红外光谱仪(NIRS)连续监测患者双侧脑组织氧饱和度(rScO2)。主要终点事件为院内中枢神经系统并发症(ND),比较ND组和NND(无ND)组患者术中rScO2值,分析ND发生的危险因素及其与术中rScO2变化的相关性。结果:25例(38.5%)患者出现ND,40例(61.5%)未出现ND(NND组)。ND组患者术中双侧rScO2最低值明显低于NND组(P<0.05)。ND组的术后各时间点rScO2值均低于NND组(P<0.05)。Logistic回归分析示,夹层累及颈动脉(P=0.005)、术前尿素氮升高(P=0.004)、术中左侧rScO2降低(P=0.008)是术后发生ND的危险因素。进一步分组示左侧rScO2min<55%是术后发生ND的危险因素(P=0.011)。结论:术中左侧rScO2降低是术后发生ND的危险因素;其最低值<55%是术后发生ND的危险因素。

Objective:To explore the correlation between regional cerebral oxygen saturation(rScO2)and postoperative neurological prognosis during adults aortic arch surgery.Methods:We observed and collected data from 65 patients who underwent aortic arch replacement surgery with moderate hypothermic circulatory arrest(MHCA),from July 2018 to October 2018,in Beijing Anzhen Hospital.Near-infrared spectroscopy(NIRS)FORE-SIGHT CASMED was applied to monitor patients’rScO2 continuously.The primary clinical endpoints were central neurological dysfunction(ND).Compare the intraoperative rSO2 values between ND group and NND(non-neurological dysfunction)group,analyze the risk factors of ND,and explore further the correlation between rScO2 and ND.Results:25(38.5%)patients occurred ND,other 40(61.5%)didn’t(NND group).The intraoperative bilateral rScO2min in ND group was significantly lower than NND group(P<0.05),and the rScO2 values at each time point after operation in ND group were significantly lower than NND group(P<0.05).Logistic regression analysis showed that carotid artery involved ratio(P=0.005),elevated level of preoperative urea nitrogen(P=0.004),reduced left rScO2(P=0.008)were independent risk factors of ND.Further,the left rScO2min<55%was an independent risk factor of ND(P=0.011).Conclusions:Reduced left rScO2 during operation was an independent risk factor of ND;further more,the left rScO2min<55%was an independent risk factor of ND.