颞浅动脉压结合颈内静脉血氧饱和度监测用于深低温停循环选择性脑灌注流量选择  

Balance cerebral perfusion with superficial temporal artery pressure plus jugular bulb oxyhemoglobin saturation improve neurologic outcome during thoracic aorta surgery

作　　者：刘锴 肖文[1] 高扬 凌中义[1] 黄维勤[1] Liu Kai;Xiao Wen;Gao Yang;Ling Zhongyi;Huang Weiqin(Department of Anesthesiology, Wuhan Asia Heart Hospital, Wuhan 430022, China)

机构地区：[1]武汉亚洲心脏病医院麻醉科,430022

出　　处：《国际麻醉学与复苏杂志》2019年第7期654-658,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的 分析颞浅动脉压结合颈内静脉血氧饱和度(jugular bulb oxyhemoglobin saturation, SjO2)监测在胸主动脉手术中对脑灌注流量选择的临床效果。 方法 2014年9月至2017年10月期间96例将接受胸主动脉手术的患者,采用随机数字表法分成两组(每组48例):研究组和对照组。术中采用深低温停循环(deep hypothermia circulatory arrest, DHCA)和选择性脑灌注(selective cerebral perfusion, SCP)方法,研究组监测颞浅动脉压结合SjO2,对照组根据临床经验监测SjO2。比较两组术中脑灌注及血流速度的变化,评价术后神经功能障碍的发生率。 结果 研究组SCP流量明显低于对照组,差异有统计学意义(P<0.05)。研究组患者苏醒时间、拔管时间、ICU停留时间明显短于对照组,永久性神经功能障碍(permanent neurological dysfunction, PND)和短暂性神经功能障碍(transient neurological dysfunction, TND)发生率明显少于对照组,差异有统计学意义(P<0.05)。 结论 颞浅动脉压结合SjO2监测可平衡脑灌注,在胸主动脉手术中使用该法监测脑灌注,其低流速不会增加神经功能障碍的发生率。Objective The aim of this study is to analyze superficial temporal artery plus jugular bulb oxyhemoglobin saturation (SjO2) monitoring during thoracic aortic procedure with regard to neurologic outcomes. Methods We performed a prospective study of patients undergoing thoracic aortic surgery. Between Sep. 2014 and Oct. 2017, 96 patients undergoing thoracic aortic procedure were recruited and divided into two group by random number table method: study group and control group. Circulatory maintenance included deep hypothermia circulatory arrest (DHCA) and selective cerebral perfusion (SCP) method during operation. Superficial temporal artery and SjO2 of patients in study group were monitored. Whereas, only SjO2 was monitored based on clinical experience of patients in control group. In order to evaluate the incidences of postoperative neurological dysfunction, the cerebral perfusion rate and blood flow rate during the surgery of patients in study group and control group were compared. Results The flow rate of SCP in the study group was significantly lower than that in the control group (P<0.05). The recovery time, extubation time and intensive care unit(ICU) residence time of the patients in the study group were significantly shorter than the time values in the control group. In addition, the incidences of permanent neurological dysfunction (PND) and transient neurological dysfunction (TND) in the study group were significantly lower than the incidences in the control group. The difference was statistically significant (P<0.05). Conclusions The application of monitoring superficial temporal artery plus SjO2 can benefit to cerebral perfusion and decrease the neurological injury.

关 键 词：颞浅动脉 颈内静脉 血氧饱和度 深低温停循环 脑保护 胸主动脉外科 

分 类 号：R614[医药卫生—麻醉学]