脑氧监测指导A型夹层术中的温度管理

目的:分析脑氧饱和度(rSO2)监测指导A型夹层术中温度管理的可行性和有效性。方法:我院2018年2月至2018年12月期间,共77例A型主动脉夹层的患者纳入研究,男性44例,女性33例,采用随机数字法将患者分为两组:常规组和脑氧监测指导组。分析各组病例术中不同温度管理策略临床疗效的差异。结果:两组病例术中主动脉阻断时间,脑保护时间差异无统计学意义,监测组体外循环时间(142.03±30.01)min低于常规组(189.90±66.87)min,P<0.05],降、复温时间常规组(45.71±6.1)min和(136.32±40.23)min,脑氧监测指导组(30.29±6.29)和(108.5±21.7)min,差异有统计学意义。乳酸和血糖水平为分别(9.95±3.76)vs.(5.58±2.96)mmol/L,(17.78±3.77)vs.(12.91±4.3)mmol/L,P<0.05],差异有统计学意义。两组患者术后卒中及需要透析的急性肾衰竭发生率,差异有统计学意义(17.5%vs.2.7%,10%vs.零)。二次开胸止血发生,医院死亡率、短暂性脑缺血发生率两组相似(P>0.05)。结论:在A型主动脉夹层术中,靶向温度降至24~26℃时,用rSO2监测指导降复温速率及灌注流量,患者的CPB时间明显减少,乳酸及血糖增加不明显,术后相关的并发症减少。

Cerebral oxygen monitoring to guide temperature management strategy during type a aortic dissection

Objective:To evaluate the feasibility and effectiveness of using regional cerebral oxygen saturation(r SO2)to guide the temperature control strategy in aortic dissection surgeries.Methods:We enrolled 77 cases(44 male,33 female)of aortic dissection patients from February 2018 to December 2018,which were randomly divided into conventional group and cerebral oxygen saturation group based on random number method.No statistic difference was found between the pre-operation data.The different outcomes between the two temperature control strategies were compared.Results:There were no statistic difference in aortic occlusion time and brain protection time.The extracorporeal cycle time were significantly shorter in the cerebral oxygen saturation group(142.03±30.01)vs.(189.90±66.87)min,P<0.05],as well as the cooling time(30.29±6.29)vs.(45.71±6.1)min,P<0.05]and rewarming time(108.5±21.7)vs.(136.32±40.23)min,P<0.05].The lactate level was(5.58±2.96)mmol/L in the cerebral oxygen saturation group and(9.95±3.76)mmol/L in the conventional group,respectively(P<0.05).The glucose level were more stable in the cerebral oxygen saturation group(12.91±4.3)vs.(17.78±3.77)mmol/L,P<0.05].The postoperative cerebral stroke incidence and acute kidney failure incidence were lower in the cerebral oxygen saturation group(17.5%vs.2.7%,10%vs.0).No statistical differences were found in re-operation incidence,in-hospital mortality and transient cerebral ischemia attack incidence.Conclusions:It was feasible and effective to use r SO2 guiding the temperature control strategy(including the cooling rate,rewarming rate,and perfusing flow)in aortic dissection surgeries with shortened extracorporeal cycle time,stabilize lactate and glucose level,and reduced post-operation complications.