Objective: To evaluate the use of near-infrared spectroscopy for monitoring cerebral oxygenation under different cardiopulmonary bypass models. Method: Twenty-four patients with ventricular septal defect and pulmonary...Objective: To evaluate the use of near-infrared spectroscopy for monitoring cerebral oxygenation under different cardiopulmonary bypass models. Method: Twenty-four patients with ventricular septal defect and pulmonary hypertension undergoing open-heart surgery were assigned eight each to three groups, with respect to different cardiopulmonary bypass models: moderate hypothermia cardiopulmonary bypass, deep hypothermia low flow and deep hypothermia circulatory arrest. For each patient, cerebral oxygenation with near-infrared spectroscopy were monitored and the relative concentration changes in cerebral oxygenated hemoglobin, deoxygenated hemoglobin and oxidized cytochrome aa3 were calculated. Electroencephalography, biochemical indicators such as neuron-specific enolase and lactate, and performed correlation analyses for near-infrared spectroscopy data and biochemical indicators were also measured. Results: Near-infrared spectroscopy data and biochemical indicators for moderate hypothermia cardiopulmonary bypass and deep hypothermia low flow group showed no correlation. For deep hypothermia circulatory arrest group, oxygenated hemoglobin signal declined to a plateau （nadir） during the circulatory arrest period. The duration from reaching nadir until reperfusion “oxygenated hemoglobin signal nadir-time", and the minimum values of oxygenated hemoglobin, and oxidized cytochrome aa3 were closely correlated with increasing neuron-specific enolase and lactate. And, all patients whose oxygenated hemoglobin signal nadir-time was less than 35 min were free from behavioral evidence of brain injury. Conclusion: Near-infrared spectroscopy data including oxygenated hemoglobin signal nadir-time and the minimum of oxygenated hemoglobin and oxidized cytochrome aa3 showed strong correlation with other cerebral function assessment for deep hypothermia circulatory arrest. Oxygenated hemoglobin signal nadir-time determined by near-infrared spectroscopy can be useful in predicting the safe duration of circulatory arrest.展开更多
Background:The aortic arch replacement and cardiopulmonary bypass(CPB)are both associated with the early mortality after cardiothoracic surgery.This study aimed to investigate the relationship between CPB time and 90-...Background:The aortic arch replacement and cardiopulmonary bypass(CPB)are both associated with the early mortality after cardiothoracic surgery.This study aimed to investigate the relationship between CPB time and 90-day post-operative mortality in patients undergoing aortic arch surgery using the frozen elephant trunk(FET)technique with selective ante-grade cerebral perfusion(SACP).Methods:We retrospectively reviewed data of 377 adult patients undergoing aortic arch surgery via FET with SACP from July 1,2017 to December 31,2018 at Beijing Anzhen Hospital.The baseline characteristics,intra-operative data,and post-operative data were collected.Univariate and multivariate Cox regression analyses were used to determine independent predictors of 90-day postoperative mortality.Results:The 90-day post-operative mortality was 13.53%.The 78.51%of patients were men.There were 318(84.35%)type A aortic dissections and 28(7.43%)aortic aneurysms.Among those,264(70.03%)were emergency operations.Median CPB time was 202.0(176.0,227.0)min.Multivariate Cox regression analysis revealed that CPB time was independently associated with 90-day post-operative mortality after adjusting confounding factors(hazard ratio:1.21/10 min increase in CPB time,95%confidence interval:1.15–1.27,P<0.001).Kaplan-Meier analysis based on CPB time tertiles revealed that the top tertile(median 236.0 min)was associated with reduced survival rate compared with middle and bottom tertiles(P<0.001).Each sub-group analysis based on the complexity of the underlying disease process showed similar associations between CPB time and 90-day post-operative mortality.Conclusions:CPB time remains a significant factor in determining 90-day post-operative mortality in patients undergoing aortic arch surgery using FET with SACP.Surgeons should be aware of the relationship between CPB time and 90-day post-operative mortality during operative procedures and avoid extended CPB time as far as possible.展开更多
目的：研究小儿法洛四联症（tetralogy of Fallot,TOF）一期根治术后影响呼吸机辅助呼吸时间的因素,以更好地掌握拔管时机,提高外科治疗效果。方法：分析2009年1月至2009年12月期间行TOF一期根治手术的患儿130例。用多元逐步logistic回...目的：研究小儿法洛四联症（tetralogy of Fallot,TOF）一期根治术后影响呼吸机辅助呼吸时间的因素,以更好地掌握拔管时机,提高外科治疗效果。方法：分析2009年1月至2009年12月期间行TOF一期根治手术的患儿130例。用多元逐步logistic回归分析法,分析性别、年龄、体质量、合并其他畸形、McGoon值、室缺大小、主动脉骑跨程度、右室流出道是否跨瓣增宽、体外循环时间、主动脉阻断时间、左心室舒张末期容积指数等指标对呼吸机辅助呼吸时间的影响。结果：130例患儿呼吸机辅助呼吸时间为5~192（47.59±9.42）h。多元逐步logistic回归分析显示McGoon值和体外循环时间是机械通气使用时间的影响因素。结论：McGoon值〈1.5,体外循环时间〉100 min是延长机械通气时间的影响因素。展开更多
文摘Objective: To evaluate the use of near-infrared spectroscopy for monitoring cerebral oxygenation under different cardiopulmonary bypass models. Method: Twenty-four patients with ventricular septal defect and pulmonary hypertension undergoing open-heart surgery were assigned eight each to three groups, with respect to different cardiopulmonary bypass models: moderate hypothermia cardiopulmonary bypass, deep hypothermia low flow and deep hypothermia circulatory arrest. For each patient, cerebral oxygenation with near-infrared spectroscopy were monitored and the relative concentration changes in cerebral oxygenated hemoglobin, deoxygenated hemoglobin and oxidized cytochrome aa3 were calculated. Electroencephalography, biochemical indicators such as neuron-specific enolase and lactate, and performed correlation analyses for near-infrared spectroscopy data and biochemical indicators were also measured. Results: Near-infrared spectroscopy data and biochemical indicators for moderate hypothermia cardiopulmonary bypass and deep hypothermia low flow group showed no correlation. For deep hypothermia circulatory arrest group, oxygenated hemoglobin signal declined to a plateau （nadir） during the circulatory arrest period. The duration from reaching nadir until reperfusion “oxygenated hemoglobin signal nadir-time", and the minimum values of oxygenated hemoglobin, and oxidized cytochrome aa3 were closely correlated with increasing neuron-specific enolase and lactate. And, all patients whose oxygenated hemoglobin signal nadir-time was less than 35 min were free from behavioral evidence of brain injury. Conclusion: Near-infrared spectroscopy data including oxygenated hemoglobin signal nadir-time and the minimum of oxygenated hemoglobin and oxidized cytochrome aa3 showed strong correlation with other cerebral function assessment for deep hypothermia circulatory arrest. Oxygenated hemoglobin signal nadir-time determined by near-infrared spectroscopy can be useful in predicting the safe duration of circulatory arrest.
文摘Background:The aortic arch replacement and cardiopulmonary bypass(CPB)are both associated with the early mortality after cardiothoracic surgery.This study aimed to investigate the relationship between CPB time and 90-day post-operative mortality in patients undergoing aortic arch surgery using the frozen elephant trunk(FET)technique with selective ante-grade cerebral perfusion(SACP).Methods:We retrospectively reviewed data of 377 adult patients undergoing aortic arch surgery via FET with SACP from July 1,2017 to December 31,2018 at Beijing Anzhen Hospital.The baseline characteristics,intra-operative data,and post-operative data were collected.Univariate and multivariate Cox regression analyses were used to determine independent predictors of 90-day postoperative mortality.Results:The 90-day post-operative mortality was 13.53%.The 78.51%of patients were men.There were 318(84.35%)type A aortic dissections and 28(7.43%)aortic aneurysms.Among those,264(70.03%)were emergency operations.Median CPB time was 202.0(176.0,227.0)min.Multivariate Cox regression analysis revealed that CPB time was independently associated with 90-day post-operative mortality after adjusting confounding factors(hazard ratio:1.21/10 min increase in CPB time,95%confidence interval:1.15–1.27,P<0.001).Kaplan-Meier analysis based on CPB time tertiles revealed that the top tertile(median 236.0 min)was associated with reduced survival rate compared with middle and bottom tertiles(P<0.001).Each sub-group analysis based on the complexity of the underlying disease process showed similar associations between CPB time and 90-day post-operative mortality.Conclusions:CPB time remains a significant factor in determining 90-day post-operative mortality in patients undergoing aortic arch surgery using FET with SACP.Surgeons should be aware of the relationship between CPB time and 90-day post-operative mortality during operative procedures and avoid extended CPB time as far as possible.
文摘目的：研究小儿法洛四联症（tetralogy of Fallot,TOF）一期根治术后影响呼吸机辅助呼吸时间的因素,以更好地掌握拔管时机,提高外科治疗效果。方法：分析2009年1月至2009年12月期间行TOF一期根治手术的患儿130例。用多元逐步logistic回归分析法,分析性别、年龄、体质量、合并其他畸形、McGoon值、室缺大小、主动脉骑跨程度、右室流出道是否跨瓣增宽、体外循环时间、主动脉阻断时间、左心室舒张末期容积指数等指标对呼吸机辅助呼吸时间的影响。结果：130例患儿呼吸机辅助呼吸时间为5~192（47.59±9.42）h。多元逐步logistic回归分析显示McGoon值和体外循环时间是机械通气使用时间的影响因素。结论：McGoon值〈1.5,体外循环时间〉100 min是延长机械通气时间的影响因素。
文摘目的:观察体外循环下小儿先天性心脏病术后持续输鱼精蛋白对肝素反跳的影响。方法:60例先天性心脏病患者随机分为两组,实验组(P组)在中和肝素后5 min至4 h内持续输注鱼精蛋白[0.4 mg/(kg.h)];对照组(C组)则输注等量的生理盐水。分别在中和肝素后2、4、6 h测量ACT(激活凝血时间),6 h内胸腔引流量,并记录24 h内输血次数。结果:C组中和肝素后2、4 h ACT时间均较中和后5 min测定值延长(P<0.05),P组在中和后2 h ACT明显低于C组(P<0.05),术后6 h出血量P组少于C组(P<0.05)。结论:常规剂量鱼精蛋白中和肝素后2～4 h ACT时间轻度延长,中和后连续输注一定量的鱼精蛋白可避免ACT时间延长,同时减少术后出血量。
