【摘要】：目的應用近紅外光譜(NIRS)監(jiān)測儀連續(xù)監(jiān)測中度低溫停循環(huán)不同選擇性腦灌注流量下的腦氧飽和度變化,為探討合適的大腦灌注流量提供臨床依據(jù)。方法選擇Stanfard A型夾層動脈瘤患者40例,根據(jù)術中不同的腦灌注流量分為5ml·kg-1·min-1低流量組(D組)和10ml·kg-1·min-1高流量組(G組),每組20例。將NIRS的探頭置于患者的額頭,分別記錄麻醉誘導后(T1)、心臟停跳時(T2)、選擇性腦灌注3min時(T3)、恢復下半身循環(huán)3min時(T4)和停體外循環(huán)后5min(T5)時記錄雙側(cè)局部大腦氧飽和度(rSO2),并測定患者圍術期靜脈血乳酸含量及術后恢復情況。結(jié)果所有患者無死亡和術后嚴重神經(jīng)系統(tǒng)并發(fā)癥發(fā)生,D組中1例患者術后出現(xiàn)輕度神經(jīng)系統(tǒng)功能異常。兩組患者各時點rSO2變化差異無統(tǒng)計學意義。兩組患者的阻斷時間、選擇性腦灌注時間、轉(zhuǎn)機時間差異均無統(tǒng)計學意義。兩組患者各時間點乳酸水平差異亦無統(tǒng)計學意義。兩組患者機械通氣時間、監(jiān)護室停留時間、術后12h引流量、術后住院時間差異均無統(tǒng)計學意義。結(jié)論成人中度低溫停循環(huán)選擇性腦灌注時,在一定時間內(nèi),5ml·kg-1·min-1和10ml·kg-1·min-1灌注流量時rSO2均在可接受的范圍內(nèi),兩種大腦灌注流量均可以滿足臨床需要。
[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.
【作者單位】： 首都醫(yī)科大學附屬北京安貞醫(yī)院體外循環(huán)及機械輔助循環(huán)科成人心臟危重癥中心;
【分類號】：R619

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