脑氧饱和度监测与急性A型主动脉夹层患者术后脑卒中相关性的研究  

Correlation between cerebral oxygen saturation monitored by near-infrared spectroscopy during operation and risk of stroke after acute type A aortic dissection surgery

作　　者：刘畅[1,2] 薛云星[2] 陈杨[2] 王东进[1,2] Liu Chang;Xue Yunxing;Chen Yang;Wang Dongjin(Department of Cardio Thoracic Surgery,Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing 210008,China;Department of Cardio Thoracic Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京中医药大学中西医结合鼓楼临床医学院心胸外科,南京210008 [2]南京大学医学院附属鼓楼医院心胸外科,南京210008

出　　处：《中华心血管病杂志》2022年第8期761-766,共6页Chinese Journal of Cardiology

摘　　要：目的探讨近红外光谱(NIRS)脑氧饱和度监测与急性A型主动脉夹层患者术后脑卒中的相关性,为术中NIRS监测提供证据。方法纳入2018—2020年在南京鼓楼医院心胸外科接受急诊手术治疗及经右腋动脉选择性单侧脑灌注的急性A型主动脉夹层的患者193例。NIRS用于术中脑灌注的监测,记录基础值和深低温停循环期间的最低值。根据术后有无卒中发生分为无卒中组(n=178,92.2%)和卒中组(n=15,7.8%)。对比分析两组患者术前、术中和术后临床差异,并分析最低NIRS值和NIRS变化值[(基础-最低)/基础]与术后卒中发生的关系。结果与无卒中组相比,卒中组术前合并心房颤动(6.7%比0.6%,P=0.026)和低血压(26.7%比9.0%,P=0.031)发生比例更高。两组患者手术方式无差异,但卒中组手术中体外循环时间长于无卒中组[(256.1±84.8)h比(217.8±58.4)h,P=0.020]。卒中组术后机械通气时间[(139.3±172.8)h比(35.6±45.6)h,P<0.001],气管切开(20.0%比1.1%,P<0.001)、急性肾损伤(73.3%比30.3%,P=0.001)和连续性肾替代治疗比例(46.7%比11.8%,P<0.001),以及死亡率(20.0%比5.1%,P=0.022)均高于非卒中组。两组患者术中左侧和右侧基础NIRS、深低温停循环期间最低NIRS值差异均无统计学意义,但卒中组右侧NIRS变化值大于无卒中组(15.2%±15.7%比9.2%±7.0%,P=0.006)。结论NIRS用于急性A型主动脉夹层术中深低温停循环期间的脑氧饱和度监测对控制脑氧供需平衡具有指导价值,相较于最低NIRS值,NIRS变化值与术后卒中更具有相关性。Objective Near-infrared spectroscopy(NIRS)is widely used for intraoperative cerebral oxygen saturation monitoring in patients with acute type A aortic dissection.This study aimed to investigate the correlation between NIRS-derived oxygen saturation and risk of postoperative stroke.Methods This study included 193 patients with acute type A aortic dissection undergoing emergency surgery and elective unilateral cerebral perfusion via the right axillary artery at the Department of Cardiothoracic Surgery,Nanjing Drum Tower Hospital,Nanjing,China,from 2018 to 2020.NIRS was used for intraoperative cerebral oxygen saturation monitoring,and the basal values and the lowest values of cerebral oxygen saturation during deep hypothermic circulatory arrest(DHCA)were recorded.The patients were divided into no-stroke group(n=178,92.2%)and stroke group(n=15,7.8%)according to the absence or presence of postoperative stroke.The differences in preoperative,operative and postoperative clinical differences between the two groups were compared,and the relationship between the lowest cerebral oxygen saturation value and the change in cerebral oxygen saturation value((base-lowest)/basal)and postoperative stroke were analyzed.Results The proportion of preoperative atrial fibrillation(6.7%vs.0.6%,P=0.026),and the proportion of preoperative hypotension(26.7%vs.9.0%,P=0.031)were significantly higher in the stroke group than no-stroke group.There were no differences in the surgical approach between the two groups.Cardiopulmonary bypass(CPB)time((256.1±84.8)h vs.(217.8±58.4)h,P=0.020),postoperative mechanical ventilation time((139.3±172.8)h vs.(35.6±45.6)h,P<0.001)were significantly longer in stroke group as compared to no-stroke group.Incidence of postoperative tracheotomy(20.0%vs.1.1%,P<0.001),acute kidney injury(73.3%vs.30.3%,P=0.001)and continuous renal replacement therapy(46.7%vs.11.8%,P<0.001)as well as mortality(20.0%vs.5.1%,P=0.022)were significantly higher in the stroke group than in non-stroke group.There was no significant differ

关 键 词：动脉瘤 夹层 近红外光谱 脑氧饱和度监测 脑卒中 

分 类 号：R654.3[医药卫生—外科学] R743.3[医药卫生—临床医学]