成人中度低温停循环手术中不同选择性脑灌注流量对脑氧饱和度的影响

发布时间：2018-08-05 20:08

【摘要】：目的应用近红外光谱(NIRS)监测仪连续监测中度低温停循环不同选择性脑灌注流量下的脑氧饱和度变化,为探讨合适的大脑灌注流量提供临床依据。方法选择Stanfard A型夹层动脉瘤患者40例,根据术中不同的脑灌注流量分为5ml·kg-1·min-1低流量组(D组)和10ml·kg-1·min-1高流量组(G组),每组20例。将NIRS的探头置于患者的额头,分别记录麻醉诱导后(T1)、心脏停跳时(T2)、选择性脑灌注3min时(T3)、恢复下半身循环3min时(T4)和停体外循环后5min(T5)时记录双侧局部大脑氧饱和度(rSO2),并测定患者围术期静脉血乳酸含量及术后恢复情况。结果所有患者无死亡和术后严重神经系统并发症发生,D组中1例患者术后出现轻度神经系统功能异常。两组患者各时点rSO2变化差异无统计学意义。两组患者的阻断时间、选择性脑灌注时间、转机时间差异均无统计学意义。两组患者各时间点乳酸水平差异亦无统计学意义。两组患者机械通气时间、监护室停留时间、术后12h引流量、术后住院时间差异均无统计学意义。结论成人中度低温停循环选择性脑灌注时,在一定时间内,5ml·kg-1·min-1和10ml·kg-1·min-1灌注流量时rSO2均在可接受的范围内,两种大脑灌注流量均可以满足临床需要。
[Abstract]:Objective to continuously monitor the changes of cerebral oxygen saturation under different selective cerebral perfusion flow in moderate hypothermia circulatory arrest by using near infrared spectrum (NIRS) monitor, and to provide clinical basis for the study of appropriate cerebral perfusion flow. Methods 40 patients with Stanfard A dissecting aneurysm were divided into 5ml kg-1 min-1 low flow group (D group) and 10ml kg-1 min-1 high flow group (G group). Place the NIRS probe on the patient's forehead, Bilateral regional cerebral oxygen saturation (rSO2) was recorded after anesthesia induction (T1), cardiac arrest (T2), selective cerebral perfusion of 3min (T3), recovery of lower body circulation 3min (T4) and 5min (T5) after cardiopulmonary bypass. Content and postoperative recovery. Results in group D, there was no death and severe neurological complications. One patient had mild neurological dysfunction after operation. There was no significant difference in rSO2 between the two groups at different time points. There was no significant difference in blocking time, selective cerebral perfusion time and transit time between the two groups. There was no significant difference in lactate levels between the two groups at different time points. There was no significant difference between the two groups in the time of mechanical ventilation, the duration of stay in the monitor unit, the drainage flow at 12 hours after operation and the time of hospitalization after operation. Conclusion during selective cerebral perfusion of moderate hypothermic circulatory arrest in adults, both rSO2 and 10ml kg-1 min-1 perfusion flow were within an acceptable range in a certain period of time, both of which could meet the clinical needs.
【作者单位】：首都医科大学附属北京安贞医院体外循环及机械辅助循环科成人心脏危重症中心;
【分类号】：R619

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