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中华脑血管病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 264 -267. doi: 10.11817/j.issn.1673-9248.2020.05.003

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局部脑氧饱和度监测在心脑血管手术中预防脑缺血的研究进展
李刚1, 李民1,()   
  1. 1. 100191 北京大学第三医院麻醉科
  • 收稿日期:2020-02-20 出版日期:2020-10-01
  • 通信作者: 李民
  • 基金资助:
    北京大学第三医院回国人员启动基金(Y78496-01)

Progress of regional cerebral oxygen saturation monitoring in the prevention of cerebral ischemia during cardiocerebrovascular surgery

Gang Li1, Min Li1,()   

  1. 1. Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
  • Received:2020-02-20 Published:2020-10-01
  • Corresponding author: Min Li
  • About author:
    Corresponding author: Li Min, Email:
引用本文:

李刚, 李民. 局部脑氧饱和度监测在心脑血管手术中预防脑缺血的研究进展[J]. 中华脑血管病杂志(电子版), 2020, 14(05): 264-267.

Gang Li, Min Li. Progress of regional cerebral oxygen saturation monitoring in the prevention of cerebral ischemia during cardiocerebrovascular surgery[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2020, 14(05): 264-267.

心脑血管手术数量和技术的迅猛发展对心脑血管手术麻醉提出了更高的要求和更新的挑战。脑灌注不足已成为影响心脑血管手术预后的重要危险因素。近年来,近红外线光谱技术(NIRS)作为目前唯一的无创脑氧监测技术,因具有无创、连续、灵敏、实时的优点,在心脑血管手术等领域得到广泛应用。通过检测人局部脑组织氧饱和度(rScO2),评估脑部氧的供需平衡状况和脑血流量变化情况,有助于优化围手术期管理,降低术后脑卒中等中枢神经系统并发症发生率、缩短住院时间、改善患者预后。本文就NIRS监测脑氧饱和度的基本原理、正常值与临床意义、心脑血管手术中的临床应用及其对患者围手术期脑缺血的预测价值等方面进行综述。

Both the recent surge in the number and the rapid development of technology of cardio-cerebrovascular surgery put forward higher requirements and newer challenges to the anesthesia of cardio-cerebrovascular surgery. Cerebral hypoperfusion has become an important risk factor for the prognosis of cardio-cerebrovascular surgery. In recent years, near infrared spectroscopy (NIRS), as the only noninvasive brain oxygen monitoring technology at present, has been widely used due to its advantages of being noninvasive, continuous, sensitive, and real-time. By detecting regional cerebral oxygen saturation (rScO2), we can evaluate the balance of brain oxygen supply and demand, optimize perioperative management, reduce the incidence of postoperative neurological complications such as stroke, shorten in-patient stay and improve the prognosis of patients. In this article, we review the fundamental principles, normal value and clinical significance of monitoring cerebral oxygen saturation by NIRS, the clinical application in cardio-cerebrovascular surgery and the predictive value in postoperative cerebral ischemia.

1
Selim M. Perioperative Stroke [J]. N Engl J Med, 2007, 356(7): 706-713.
2
Patel N, Minhas JS, Chung EM. Risk Factors Associated with Cognitive Decline after Cardiac Surgery: A Systematic Review [J]. Cardiovasc Psychiatry Neurol, 2015, 2015: 370612.
3
Mrkobrada M, Hill MD, Chan MTV, et al. Covert stroke after non-cardiac surgery: a prospective cohort study [J]. Br J Anaesth, 2016, 117(2): 191-197.
4
Group PS, Devereaux PJ, Yang H, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial [J]. Lancet, 2008, 371(9627): 1839-1847.
5
Brady K, Joshi B, Zweifel C, et al. Real-time continuous monitoring of cerebral blood flow autoregulation using near-infrared spectroscopy in patients undergoing cardiopulmonary bypass (Article) [J]. Stroke, 2010, 41(9): 1951-1956.
6
Kim MB, Ward DS, Cartwright CR, et al. Estimation of jugular venous O2 saturation from cerebral oximetry or arterial O2 saturation during isocapnic hypoxia [J]. J Clin Monit Comput, 2000, 16(3): 191-199.
7
Chan MJ, Chung T, Glassford NJ, et al. Near-Infrared Spectroscopy in Adult Cardiac Surgery Patients: A Systematic Review and Meta-Analysis [J]. J Cardiothorac Vasc Anesth, 2017, 31(4): 1155-1165.
8
Scheeren TW, Schober P, Schwarte LA. Monitoring tissue oxygenation by near infrared spectroscopy (NIRS): background and current applications [J]. J Clin Monit Comput, 2012, 26(4): 279-287.
9
Fedorow C, Grocott HP. Cerebral monitoring to optimize outcomes after cardiac surgery [J]. Curr Opin Anaesthesiol, 2010, 23(1): 89-94.
10
Fearn SJ, Pole R, Wesnes K, et al. Cerebral injury during cardiopulmonary bypass: emboli impair memory [J]. J Thorac Cardiovasc Surg, 2001, 121(6): 1150-1160.
11
Kato S, Yoshitani K, Kubota Y, et al. Effect of posture and extracranial contamination on results of cerebral oximetry by near-infrared spectroscopy [J]. J Anesth, 2017, 31(1): 103-10.
12
Rigamonti A, Scandroglio M, Minicucci F, et al. A clinical evaluation of near-infrared cerebral oximetry in the awake patient to monitor cerebral perfusion during carotid endarterectomy [J]. J Clin Anesth, 2005, 17(6): 426-430.
13
Friedell ML, Clark JM, Graham DA, et al. Cerebral oximetry does not correlate with electroencephalography and somatosensory evoked potentials in determining the need for shunting during carotid endarterectomy [J]. J Vasc Surg, 2008, 48(3): 601-606.
14
Bernardi MH, Wahrmann M, Dworschak M, et al. Carotid artery blood flow velocities during open-heart surgery and its association with delirium: A prospective, observational pilot study [J]. Medicine (Baltimore), 2019, 98(50): e18234.
15
Samra SK, Dy EA, Welch K, et al. Evaluation of a Cerebral Oximeter as a monitor of cerebral ischemia during carotid endarterectomy [J]. Anesthesiology, 2000, 93(4): 964-970.
16
Pennekamp CWA, Immink RV, den Ruijter HM, et al. Near-infrared spectroscopy to indicate selective shunt use during carotid endarterectomy [J]. Eur J Vasc Endovasc Surg, 2013, 46(4): 397-403.
17
Kuzhuget R, Starodubtsev V, Ignatenko P, et al. The role of stump pressure and cerebral oximetry in predicting ischaemic brain damage during carotid endarterectomy [J]. Brain Inj, 2017, 31(13-14): 1944-1950.
18
Zheng F, Sheinberg R, Yee MS, et al. Cerebral near-infrared spectroscopy monitoring and neurologic outcomes in adult cardiac surgery patients: a systematic review [J]. Anesth Analg, 2013, 116(3): 663-676.
19
Bucerius J, Gummert JF, Borger MA, et al. Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients [J]. Ann Thorac Surg, 2003, 75(2): 472-478.
20
Edmonds HL. Pro: all cardiac surgical patients should have intraoperative cerebral oxygenation monitoring [J]. J Cardiothorac Vasc Anesth, 2006, 20(3): 445-449.
21
李林, 张铁铮, 刁玉刚. 脑氧饱和度监测指导脑灌注对主动脉弓置换术后神经系统并发症 [J]. 临床麻醉学杂志, 2018, 34(10): 941-944.
22
Ortega-Loubon C, Herrera-Gómez F, Bernuy-Guevara C, et al. Near-Infrared Spectroscopy Monitoring in Cardiac and Noncardiac Surgery: Pairwise and Network Meta-Analyses [J]. J Clin Med, 2019, 8(12): 2208.
23
Lopez MG, Pandharipande P, Morse J, et al. Intraoperative cerebral oxygenation, oxidative injury, and delirium following cardiac surgery [J]. Free Radic Biol Med, 2017, 103: 192-198.
24
Momeni M, Meyer S, Docquier MA, et al. Predicting postoperative delirium and postoperative cognitive decline with combined intraoperative electroencephalogram monitoring and cerebral near-infrared spectroscopy in patients undergoing cardiac interventions [J]. J Clin Monit Comput, 2019, 33(6): 999-1009.
25
Lee KF, Wood MD, Maslove DM, et al. Dysfunctional cerebral autoregulation is associated with delirium in critically ill adults [J]. J Cereb Blood Flow Metab, 2019, 39(12): 2512-2520.
26
Needham MJ, Webb CE, Bryden DC. Postoperative cognitive dysfunction and dementia: what we need to know and do [J]. Br J Anaesth, 2017, 119(suppl 1): i115-i125.
27
Sun X, Ellis J, Corso PJ, et al. Mortality predicted by preinduction cerebral oxygen saturation after cardiac operation [J]. Ann Thorac Surg, 2014, 98(1): 91-96.
28
Slater JP, Guarino T, Stack J, et al. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery [J]. Ann Thorac Surg, 2009, 87(1): 36-44; discussion 44-35.
29
de Tournay-Jette E, Dupuis G, Bherer L, et al. The relationship between cerebral oxygen saturation changes and postoperative cognitive dysfunction in elderly patients after coronary artery bypass graft surgery [J]. J Cardiothorac Vasc Anesth, 2011, 25(1): 95-104.
30
Fudickar A, Peters S, Stapelfeldt C, et al. Postoperative cognitive deficit after cardiopulmonary bypass with preserved cerebral oxygenation: a prospective observational pilot study [J]. BMC Anesthesiol, 2011, 11: 7.
31
Pennekamp CW, Immink RV, den Ruijter HM, et al. Near-infrared spectroscopy can predict the onset of cerebral hyperperfusion syndrome after carotid endarterectomy [J]. Cerebrovasc Dis, 2012, 34(4): 314-321.
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