近红外光谱监测体外循环手术中脑组织氧合状况的研究  

Monitoring Cerebral Oxygenation Using Near Infrared Spectroscopy during Cardiopulmonary Bypass Surgery

作　　者：腾轶超[1] 丁海曙[1] 龚庆成[2] 贾在申[2] 黄岚[1] 王培勇[1] 

机构地区：[1]清华大学医学院生物医学工程系,北京100084 [2]北京安贞医院体外循环科,北京100029

出　　处：《光谱学与光谱分析》2006年第5期828-832,共5页Spectroscopy and Spectral Analysis

基　　金：国家自然科学基金(69778024);国家教育振兴项目(Jc2001022)资助

摘　　要：体外循环手术中,为防止因脑氧供需失衡导致脑缺氧,就要实时监测患者局部脑组织的氧合状况,以根据其变化调整生理参数或采取应急手段。用该研究小组自行研制的近红外仪器(使用一个双波长的近红外光源和两个近红外检测器)监测心脏手术中患者的脑氧,可以求出局部脑组织血红蛋白浓度的变化,并根据稳态空间分辨光谱(SRS)算法求出局部脑组织的氧饱和度(rSO2)。体外循环中用监护仪监测患者的混合静脉血氧饱和度(SvO2)等生理参数。测得的血红蛋白浓度变化容易受到干扰,而rSO2的抗干扰性能较好。rSO2在整个手术过程中都可以监测到,而SvO2只能在体外循环过程中监测到。多数患者rSO2和SvO2存在正向相关性,但二者的相关系数并不很高。这是因为SvO2是大静脉的血氧饱和度,而测得的rSO2反映局部脑组织的氧合状况,二者的生理意义不同。实验结果表明,体外循环手术中rSO2可以反映患者脑组织氧合状况的变化,而仅仅监测SvO2是不够的。To avoid cerebral hypoxia caused by the imbalance between cerebral oxygen supply and consumption, regional cerebral oxygenation of patients need to be monitored at real time during cardiopulmonary bypass （CPB） surgery, and the physiological parameters can be regulated and emergent treatment can be used according to it. Using the near infrared （NIR） instrument developed by our group, cerebral oxygenation of the patients under cardiac surgery was monitored. The instrument consists of a two-wavelength near infrared light source and two near infrared detectors. Hemoglobin concentration changes of regional cerebral tissue were calculated, and by steady-state spatially resolved spectroscopy （SRS） algorithm, regional cerebral oxygen saturation （rSO2） was also calculated. Physiological parameters of patients, such as mixed venous oxygen saturation （SvO2）, were measured by another monitor during CPB. Hemoglobin concentration changes were easily disturbed, but the anti-disturbance ability of rSO2 was good. The value of rSO2 could be detected all over the surgeries, but SvO2 could be detected only during CPB. There were positive correlations between rSO2 and SvO2 in most of the patients, but the correlation coefficients were not very high. This was because SvO2 reflects the saturation of the main venous, but rSO2 reflects regional cerebral oxygenation. So the physiological meaning of rSO2 and SvO2 is different. The results indicate that cerebral oxygenation of patients can be reflected by rSO2 during CPB, while only monitoring SvO2 is not enough.

关 键 词：体外循环 近红外光谱 局部脑组织氧饱和度 混合静脉血氧饱和度 相关系数 

分 类 号：TN21[电子电信—物理电子学] R654.1[医药卫生—外科学]