Objective To investigate the changes of cerebral oxygen supply and demand during coronary artery bypass grafting (CABG) with the mild hypothermic cardiopulmonary bypass (CPB).Methods: Adult(n=17) free of diabetes mell...Objective To investigate the changes of cerebral oxygen supply and demand during coronary artery bypass grafting (CABG) with the mild hypothermic cardiopulmonary bypass (CPB).Methods: Adult(n=17) free of diabetes mellitas, cerebral vascular diseases undergoing coronary artery bypass grafting(CABG) were selected. Jugular bulb oxygen saturation (SjO2),arterial-venous oxygen content difference (Da-VO2),and arterial-venous lactate difference (Da-VL),oxygen extract rate(O2ER)were measured at various times: before CPB, during cooling at nasopharyngeal temperature (NPT) 33℃,during stable hypothermia, during rewarming at NPT 37℃, and 20 minutes after CPB as well as the end of operation.Result: During rewarming, SjO2 decreased and O2ER increased significantly compared with that of pre-CPB that of stage. but Da-vL and GER did not change significantly during anesthesia in all patients. SjO2 was negatively correlated to NPT(r=-0.6423,P<0.05). Conclusion: Rewarming period is still critical for O2 desaturation of the brain. The changes of body tempera ture is an important factor affecting cerebral oxygen balance, but the critical level of SjO2 as an predictor of neurologic injure in mild hypothermic CPB is not known.展开更多
文摘目的探讨半坐位开颅患者无创脑氧饱和度(cerebral tissue oxygen saturation,SctO_(2))与颈静脉球部氧饱和度(jugular venous oxygen saturation,SjvO_(2))的影响因素。方法选取2018年4月至2020年5月首都医科大学宣武医院行半坐位听神经瘤手术的患者30例。采用Fore-sight近红外光仪监测无创SctO_(2),通过术侧颈静脉球部置管采集血液标本测定SjvO_(2)。记录半坐位切皮(T0)、硬脑膜剪开后30 min(T1)及肿瘤切除后(T2)双侧无创SctO_(2)及术侧SjvO_(2)、MAP、中心静脉压(central venous pressure,CVP)和颈静脉球部压力(jugular bulb pressure,JBP)。同时采集动脉血测定PaCO_(2)、PaO_(2),采集颈静脉球部血液标本测定颈静脉球部二氧化碳分压(pressure of carbon dioxide in the jugular venous,PjvCO_(2))、颈静脉球部氧分压(pressure of oxygen in the jugular venous,PjvO_(2))、红细胞比容(hematocrit,Hct)及乳酸(lactic acid,Lac),纳入MAP、CVP、JBP、PaCO_(2)、PaO_(2),PjvCO_(2)、PjvO_(2)、Hct及Lac进行SctO_(2)与SjvO_(2)影响因素的多元线性回归分析。结果PjvO_(2)、PjvCO_(2)、PaCO_(2)、JBP和Hct对SjvO_(2)的影响有统计学意义(P<0.05),调整后的R2=0.845;CVP、MAP及PaCO_(2)对术侧SctO_(2)的影响有统计学意义(P=0.000),调整后的R2=0.371。结论半坐位开颅患者采用SctO_(2)和SjvO_(2)监测时需考虑不同的影响因素,采取相应措施有效改善脑氧供需平衡状态。
文摘Objective To investigate the changes of cerebral oxygen supply and demand during coronary artery bypass grafting (CABG) with the mild hypothermic cardiopulmonary bypass (CPB).Methods: Adult(n=17) free of diabetes mellitas, cerebral vascular diseases undergoing coronary artery bypass grafting(CABG) were selected. Jugular bulb oxygen saturation (SjO2),arterial-venous oxygen content difference (Da-VO2),and arterial-venous lactate difference (Da-VL),oxygen extract rate(O2ER)were measured at various times: before CPB, during cooling at nasopharyngeal temperature (NPT) 33℃,during stable hypothermia, during rewarming at NPT 37℃, and 20 minutes after CPB as well as the end of operation.Result: During rewarming, SjO2 decreased and O2ER increased significantly compared with that of pre-CPB that of stage. but Da-vL and GER did not change significantly during anesthesia in all patients. SjO2 was negatively correlated to NPT(r=-0.6423,P<0.05). Conclusion: Rewarming period is still critical for O2 desaturation of the brain. The changes of body tempera ture is an important factor affecting cerebral oxygen balance, but the critical level of SjO2 as an predictor of neurologic injure in mild hypothermic CPB is not known.
