MCA血流速度-rScO_(2)监测用于指导TAR术患者顺行性脑灌注的效果

Efficacy of MCA blood flow velocity-rScO_(2) monitoring in guiding anterograde cerebral perfusion in patients undergoing TAR

目的评价大脑中动脉(MCA)血流速度-局部脑氧饱和度(rScO_(2))监测指导主动脉全弓置换(TAR)术患者顺行性脑灌注的效果。方法选择行TAR术患者98例,性别不限,年龄18~72岁,BMI 24~30 kg/m^(2),ASA分级Ⅳ级。将由外科医师决定脑灌注方式的患者纳入对照组(C组),根据指导标准选择灌注方式的患者纳入指导组(G组),每组49例。记录两组患者脑灌注方式、灌注效果、术后气管插管保留时间、ICU停留时间、总住院时间、气管切开情况、痊愈出院、术后脑卒中和死亡发生情况。结果与C组比较,G组双侧灌注比率、术后气管切开比率、脑卒中发生率和术后死亡率降低,灌注效果好比率和痊愈出院率升高(P<0.05),气管插管保留时间、ICU停留时间和住院时间差异无统计学意义(P>0.05)。结论MCA血流速度-rScO_(2)监测指导TAR术中顺行性脑灌注效果较好。

Objective To evaluate the efficacy of middle cerebral artery(MCA)blood flow velocity combined with regional saturation of cerebral oxygen(rScO_(2))monitoring in guiding anterograde cerebral perfusion in the patients undergoing total arch replacement(TAR).Methods Ninety-eight patients of either sex,aged 18-72 yr,with body mass index of 24-30 kg/m^(2),of American Society of Anesthesiologists Physical Status classificationⅣ,undergoing elective TAR,were selected.The patients whose anterograde cerebral perfusion mode was determined by the surgeon were enrolled in control group(group C),and the patients who selected the anterograde perfusion mode according to the guiding criteria were included in guidance group(group G),with 49 cases in each group.Cerebral anterograde perfusion mode,postoperative retention time of tracheal intubation,duration of stay in intensive care unit,total hospital stay,tracheotomy,recovery and discharge,postoperative stroke and death of patients were recorded in two groups.Results Compared with group C,the ratios of bilateral cerebral perfusion and postoperative tracheotomy,incidence of stroke and postoperative mortality were significantly decreased,the ratio of good perfusion and rate of recovery and discharge were increased(P<0.05),and no significant change was found in the retention time of endotracheal intubation,duration of stay in intensive care unit,and length of hospital stay in group G(P>0.05).Conclusions MCA blood flow velocity-rScO monitoring provides a good efficacy in guiding anterograde cerebral perfusion during TAR.