肾氧饱和度监测在主动脉夹层低温停循环手术中的应用

Application of renal oxygen saturation monitoring in cryogenic circulatory arrest for aortic dissection

目的观察主动脉夹层低温停循环手术中肾氧饱和度(RrSO_(2))变化,探讨其对于诊断急性肾损伤(AKI)的应用价值。方法2019年1月至2021年1月,观察40例DeBakeyⅠ型主动脉夹层患者围手术期RrSO_(2)变化。将近红外光谱仪(BGOS-600B)探头分别固定于左右肾体表定位区,持续监测RrSO_(2)。记录T1(手术开始时)、T2(体外循环开始后)、T3(体外循环阻断主动脉后)、T4(停止循环后)、T5(恢复循环后)、T6(体外循环开放主动脉后)、T7(体外循环停止后)、T8(手术结束时)等8个时间点的RrSO_(2)。应用SPSS 23.0统计软件分析。结果左右肾RrSO_(2)在T1~T8时间点的比较差异无统计学意义(T1:68.21±1.10比67.90±1.20,t=1.204,P>0.05;T2:67.92±1.02比67.79±1.24,t=0.512,P>0.05;T3:71.50±0.74比71.74±0.65,t=1.541,P>0.05;T4:53.10±1.45比53.64±1.53,t=1.620,P>0.05;T5:69.83±0.87比69.70±0.98,t=0.627,P>0.05;T6:62.39±0.72比62.28±0.87,t=0.616,P>0.05;T7:64.71±0.80比64.50±1.16,t=0.943,P>0.05;T8:66.69±1.22比66.25±0.90,t=1.836,P>0.05)。手术开始后至体外循环开始时,RrSO_(2)变化较小,T2与T1比较(67.86±1.29比68.06±1.32)差异无统计学意义(t=0.969,P>0.05)。体外循环阻断主动脉后,RrSO_(2)逐渐上升,T3高于T1(71.62±0.49比68.06±1.32),差异有统计学意义(t=22.610,P<0.05)。停止循环后,RrSO_(2)逐渐降低,T4低于T1(53.37±2.21比68.06±1.32),差异有统计学意义(t=51.040,P<0.05)。恢复循环后,RrSO_(2)再次上升,T5高于T1(69.77±0.88比68.06±1.32),差异有统计学意义(t=9.641,P<0.05)。体外循环开放主动脉后,RrSO_(2)逐渐下降,T6低于T1(62.35±0.63比68.06±1.32),比较差异有统计学意义(t=34.920,P<0.05)。体外循环停止时,RrSO_(2)轻微上升,T7低于T1(64.61±0.99比68.06±1.32),差异有统计学意义(t=18.700,P<0.05)。手术结束时,RrSO_(2)轻微上升,T8低于T1(66.46±1.15比68.06±1.32),差异有统计学意义(t=8.174,P<0.05)。结论RrSO_(2)在主动脉夹层低温停循环手术中可以较好反映肾氧合状态,有助于诊断急性肾损伤。

Objective To observe the changes of renal regional oxygenation saturation(RrSO_(2))in the operation of hypothermic circulatory arrest for aortic dissection,and to explore its application value in the diagnosis of acute kidney injury(AKI).Methods The changes of RrSO_(2) in 40 Debakey type I aortic dissection patients during perioperative period were observed from January 2019 to January 2021.The probes of near infrared spectrometer(BGOS-600B)were fixed on the left and right renal surface location area,and the RrSO_(2) was continuously monitored.RrSO_(2) values were recorded at 8 time points including T1(at the start of surgery),T2(after the start of cardiopulmonary bypass),T3(after occlusion of aorta by cardiopulmonary bypass),T4(after discontinuation of circulation),T5(after resumption of circulation),T6(after discontinuation of aorta by cardiopulmonary bypass),T7(after discontinuation of cardiopulmonary bypass)and T8(after the end of surgery).SPSS 23.0 statistical software was used for analysis.Results There was no significant difference in RrSO_(2) between left and right kidneys at T1-T8 time points(T1:68.21±1.10 vs.67.90±1.20,t=1.204,P>0.05;T2:67.92±1.02 vs.67.79±1.24,t=0.512,P>0.05;T3:71.50±0.74 vs.71.74±0.65,t=1.541,P>0.05;T3:71.50±0.74 vs.71.74±0.65,t=1.541,P>0.05;T4:53.10±1.45 vs.53.64±1.53,t=1.620,P>0.05;T5:69.83±0.87 vs.69.70±0.98,t=0.627,P>0.05;T6:62.39±0.72 vs.62.28±0.87,t=0.616,P>0.05;T7:64.71±0.80 vs.64.50±1.16,t=0.943,P>0.05;T8:66.69±1.22 vs.66.25±0.90,t=1.836,P>0.05).RrSO_(2) changed slightly from the start of surgery to the start of cardiopulmonary bypass.There was no significant difference between T2 and T1(67.86±1.29 vs.68.06±1.32,t=0.969,P>0.05).After CPB occlusion of aorta,RrSO_(2) increased gradually,and that at T3 was significantly higher than that at T1(71.62±0.49 vs.68.06±1.32;t=22.610,P<0.05).After the circulation was stopped,RrSO_(2) decreased gradually,and that at T4 was significantly lower than that at T1(53.37±2.21 vs.68.06±1.32,t=51.040,P<0.05).After the circulation resumed,RrSO_(2) increased again,and that at T5 was significantly higher than that at T1(69.77±0.88 vs.68.06±1.32,t=9.641,P<0.05).After CPB,RrSO_(2) decreased gradually,and that at T6 was significantly lower than that at T1(62.35±0.63 vs.68.06±1.32,t=34.920,P<0.05).When CPB was stopped,RrSO_(2) was slightly increased,and that at T7 was significantly lower than that at T1(64.61±0.99 vs.68.06±1.32,t=18.700,P<0.05).At the end of surgery,RrSO_(2) was slightly increased,and that at T8 was significantly lower than that at T1(66.46±1.15 vs.68.06±1.32,t=8.174,P<0.05).Conclusion RrSO_(2) can better reflect the oxygenation status of the kidney in the cryogenic circulatory arrest of aortic dissection,which is helpful for the diagnosis of AKI.