体外循环和非体外循环下冠状动脉旁路移植术中患者脑氧饱和度的变化趋势分析

Variation trend of intraoperative rScO2 in patients with OPCAB and CCABG

目的探讨体外循环和非体外循环下冠状动脉旁路移植术中患者脑氧饱和度(rScO2)的变化趋势。方法前瞻性选取2018年2月-2019年6月在上海市第一人民医院择期行冠状动脉旁路移植术的105例患者。其中,56例接受非体外循环冠状动脉旁路移植术(OPCAB),49例患者接受体外循环冠状动脉旁路移植术(CCABG)。术中分别选择T0~T9 10个时间点检测rScO2,另外记录术后7 d内术后认知功能障碍(POCD)发生率。结果 CCABG组患者手术时间长于OPCAB组(P <0.05),术中最低鼻咽温和红细胞比容(HCT)低于OPCAB组(P <0.05),术中最高血糖(Glu)和血乳酸(Lac)高于OPCAB组(P <0.05);但是两组术中最低rScO2比较,差异无统计学意义(P >0.05)。两组rScO2在不同时间、组间、变化趋势上有差别(P <0.05)。CCABG组rScO2与鼻咽温、Lac呈正相关(r=0.229和0.283,P=0.005和0.002),而OPCAB组rScO2只与Lac呈正相关(r=0.214,P=0.010)。OPCAB组和CCABG组POCD发生率分别为39.29%(22/56)和32.65%(16/49),且CCABG组POCD患者最低rScO2低于非POCD患者(P <0.05)。结论虽然OPCAB与CCABG术中患者rScO2变化趋势有差异,但是rScO2可能不是影响术后早期POCD发生的主要原因。

Objective To investigate the variation trend of intraoperative cerebral regional oxygen saturation (rScO2) in patients with off-pump coronary artery bypass (OPCAB) and convention coronary artery bypass grafting (CCABG).Methods A total of 105 patients with cardiac surgery in our hospital were selected from 2018.02 to 2019.06 and divided into OPCAB group (n=56) and CCABG group (n=49).Intraoperative rScO2 levels were detected at T0 to T9 time points.The postoperative cognitive dysfunction (POCD) during 5 to 7 d after surgery.Results Compared with OPCAB group,the surgery duration in CCABG group was longer (P < 0.05);intraoperative nasopharyngeal temperature and the lowest hematocrit value (HCT) were lower,and the highest glucose and lactate levels were higher (P < 0.05).But there was no statistical difference of the lowest rScO2 level between OPCAB group and CCABG group (P > 0.05).The rScO2 levels of the two groups among different time points,groups and trends were different (P < 0.05).By Pearson analysis,intraoperative rScO2 level was positive related with nasopharyngeal temperature or serum Lac level in CCABG group (r=0.229,P=0.005;r=0.283,P=0.002),while intraoperative rScO2 level was only positive related with serum Lac level in OPCAB group (r=0.214,P=0.010).The incidence of POCD in OPCAB group and CCABG group were respectively 39.29% (22/56) and 32.65% (16/49),while the lowest rScO2 level of POCD patients in CCABG group was lower than that of patients without POCD (P < 0.05).Conclusion It’s suggested that there would be difference of the variation trend of intraoperative rScO2 between OPCAB and CCABG,but which would be not the main reason for POCD incidence.