脑氧饱和度监测技术指导术中干预措施在降低心脏术后认知功能障碍发生率的应用

Application value of the intervening measure of cerebral oxygen saturation monitoring technique in reducing the incidence rate of postoperative cognitive dysfunction

目的:将近红外光谱学(NIRS)局部脑氧饱和度(rSO2)监测技术应用于心脏外科手术的病人,并根据其数值采取相应的干预措施,旨在降低心脏外科病人术后认知功能障碍(POCD)的发生率。方法:选取60例择期行体外循环下心脏外科手术病人,采用随机数字表法分为NIRS rSO2干预组(T组,n=30)和常规监测组(C组,n=30)。T组NIRS rSO2数值降低至基线的11%时,依次通过干预头部位置、主动脉上下腔静脉插管的位置、平均动脉压、动脉血氧饱和度、动脉血二氧化碳、血红蛋白、混合血氧饱和度将NIRS rSO2数值恢复至基线水平。C组根据麻醉医生经验使病人的生命体征维持在可以接受的水平。使用简易智能精神状态检查表评分量表和S100β蛋白、神经元特异性烯醇化酶(NSE)数值综合评估2组POCD的发生率。结果:T组术中NIRS rSO2数值高于C组(P<0.01),NSE、S100β蛋白数值低于C组(P<0.05~P<0.01),POCD的发生率小于C组(P<0.05)。结论:NIRS rSO2监测技术和术中恰当干预措施可以降低体外循环下心脏外科病人POCD的发生率,值得临床推广。

Objective:To apply the near-infrared spectroscopy regional cerebral saturation techniques(NIRS rSO2) in patients treated with cardiac surgery,take corresponding intervention measures according to its value to reduce the incidence rate of postoperative cognitive dysfunction(POCD) in cardiac surgery patients.Methods:Sixty patients treated with cardiac surgery under extracorporeal circulation were randomly divided into the NIRS rSO2 group(group T,30 cases) and routine monitoring group(group C,30 cases).In group T,after the NIRS rSO2 value decreased to the 11% of baseline,the NIRS rSO2 value could be restored to baseline by intervening the head position,position of the superior and inferior vena cava cannula,mean arterial pressure,arterial oxygen saturation,arterial carbon dioxide,hemoglobin and mixed oxygen saturation.The vital signs in group C could be maintained at an acceptable level according to the experience of anesthesiologists.The incidence rates of POCD in two groups were evaluated using MMSE scale,S100β protein and NSE values.Results:The NIRS rSO2 value in group T was higher than that in group C(P<0.01),the NSE and S100β protein value and incidence rate of POCD in group T were lower than those in group C(P<0.05 to P<0.01).Conclusions:The NIRS rSO2 monitoring techniques and appropriate intraoperative interventions can reduce the incidence rate of POCD in cardiac surgery patients with extracorporeal circulation,which is worthy of clinical promotion.