【摘要】：目的應(yīng)用近紅外光譜(NIRS)監(jiān)測(cè)儀連續(xù)監(jiān)測(cè)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(dòng)脈瘤患者40例,根據(jù)術(shù)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(dǎo)后(T1)、心臟停跳時(shí)(T2)、選擇性腦灌注3min時(shí)(T3)、恢復(fù)下半身循環(huán)3min時(shí)(T4)和停體外循環(huán)后5min(T5)時(shí)記錄雙側(cè)局部大腦氧飽和度(rSO2),并測(cè)定患者圍術(shù)期靜脈血乳酸含量及術(shù)后恢復(fù)情況。結(jié)果所有患者無(wú)死亡和術(shù)后嚴(yán)重神經(jīng)系統(tǒng)并發(fā)癥發(fā)生,D組中1例患者術(shù)后出現(xiàn)輕度神經(jīng)系統(tǒng)功能異常。兩組患者各時(shí)點(diǎn)rSO2變化差異無(wú)統(tǒng)計(jì)學(xué)意義。兩組患者的阻斷時(shí)間、選擇性腦灌注時(shí)間、轉(zhuǎn)機(jī)時(shí)間差異均無(wú)統(tǒng)計(jì)學(xué)意義。兩組患者各時(shí)間點(diǎn)乳酸水平差異亦無(wú)統(tǒng)計(jì)學(xué)意義。兩組患者機(jī)械通氣時(shí)間、監(jiān)護(hù)室停留時(shí)間、術(shù)后12h引流量、術(shù)后住院時(shí)間差異均無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論成人中度低溫停循環(huán)選擇性腦灌注時(shí),在一定時(shí)間內(nèi),5ml·kg-1·min-1和10ml·kg-1·min-1灌注流量時(shí)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(xué)附屬北京安貞醫(yī)院體外循環(huán)及機(jī)械輔助循環(huán)科成人心臟危重癥中心;
【分類號(hào)】：R619

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