局部脑氧饱和度监测在冠脉旁路移值术的应用研究

目的探讨局部脑氧饱和度监测在冠脉旁路移值术(OPCAB)中的应用价值。方法选取2018-02—2019-01在郑州市第七人民医院行OPCAB患者共有291例,均行脑氧监测,且术中尽力维持rSO2≥50%且在基础值的75%以上,称为脑氧组,于术前1 d、术后72 h和术后1周常规填写MMSE量表;选取2017-02—07在郑州市第七人民医院行OPCAB患者126例,术中未行脑氧监测,为非脑氧组,于术前1 d、术后72 h和术后1周常规填写MMSE量表。结果(1)2组患者在年龄、性别、体重指数、左心室收缩功能、高血压和糖尿病的并发症等资料无明显区别(P>0.05),2组患者术前MMSE评分无明显区别(P>0.05)。(2)2组患者术后3 d、7 d、3个月MMSE评分比较,脑氧组均明显高于非脑氧组(P<0.05),2组患者在手术时间、桥血管数量、病死率、脑血管疾病发病率无明显区别(P>0.05)。(3)2组患者在机械通气时间、重症监护时间、住院时间比较,脑氧组明显短于非脑氧组(P<0.05),住院总费用比较,脑氧组明显少于非脑氧组(P<0.05)。(4)脑氧组内根据是否出现POCD,把脑氧组内分为POCD组和非POCD组。POCD组97例中出现rSO2低于正常下限共有41例,占组内42.3%(41/97),非POCD组194例中出现rSO2低于正常下限共有54例,占组内27.8%(54/194)。POCD组内rSO2低于正常下限明显高于非POCD组(P<0.01)。结论在OPCAB中,应常规脑氧监测,尽量同时维持rSO2≥50%和基础值的75%以上,能减少脑部缺血缺氧,降低POCD发生率,缩短治疗周期,改善患者预后。

Study on the application of regional cerebral oxygen saturation monitoring in off-pump coronary artery bypass grafting

Objective To explore the application value of Regional cerebral oxygen saturation monitoring in OPCAB.Methods From February 2018 to January 2019,a total of 291 patients with OPCAB underwent regional cerebral oxygen saturation monitoring in our hospital,and they tried their best to maintain rSO2≥50%and above 75%of the basic value during the operation,which was called the brain oxygen group.The MMSE scale was routinely filled in one day before the operation,72 hours after the operation and one week after the operation.From February 2017 to July 2017,126 patients with OPCAB in our hospital were selected,none of whom underwent Regional cerebral oxygen saturation monitoring,which was called the non-cerebral oxygen group.MMSE scale was routinely filled in one day before surgery,72 hours after surgery and one week after surgery.Results There was no significant difference in age,gender,body mass index,left ventricular ejection fraction,complications of hypertension and diabetes between the two groups(P>0.05),and there was no significant difference in preoperative MMSE score between the two groups(P>0.05).The MMSE scores of the cerebral oxygen group at 3 days,7 days and 3 months after surgery were significantly higher than those of the non-cerebral oxygen group(P<0.05),and there was no significant difference between the two groups in operation time,number of bridging vessels,mortality and incidence of cerebrovascular diseases(P>0.05).Compared with the non-cerebral oxygen group,the duration of mechanical ventilation,intensive care and hospitalization in the cerebral oxygen group was significantly shortened,and the total hospitalization cost was significantly reduced.The incidence of POCD increased in the brain oxygen group when rSO2<50%and/or decreased to less than 75%of the base value.According to the presence or absence of POCD,the cerebral oxygen group was divided into POCD group and non-POCD group.In the POCD group,a total of 97 cases had rSO2 below the normal lower limit,accounting for 42.3%(41/97)in the group;in the non-POCD group,194 cases had rSO2 below the normal lower limit,accounting for 27.8%(54/194)in the group.rSO2 in the POCD group was significantly lower than the normal lower limit than that in the non-POCD group(P<0.01).Conclusion When patients with coronary heart disease undergo OPCAB,,routine cerebral oxygen monitoring should be conducted to maintain 50%rSO2 and more than 75%of the basic value as much as possible,which can reduce cerebral ischemia and hypoxia,reduce the incidence of POCD,shorten the treatment cycle and improve the prognosis of patients.