摘要
目的评价体外循环(CPB)冠状动脉旁路移植术老年患者颈内动脉血流超声参数与区域脑氧饱和度(rScO2)的相关性。方法择期CPB冠状动脉旁路移植术老年患者64例,年龄60~80岁,性别不限,BMI 18.1~28.9 kg/m^(2),ASA分级Ⅱ或Ⅲ级,NYHA分级Ⅱ或Ⅲ级,LVEF≥50%。于麻醉诱导前(T_(0))、外科切皮(T_(1))、CPB 30和60 min (取平均值,T_(2))、停CPB 30和60 min(取平均值,T_(3))时记录rScO_(2)和颈内动脉血流超声参数,包括收缩期峰值血流速度(PSV-ICA)、舒张末期血流速度(EDV-ICA)、直径(D-ICA)和血流量(Q-ICA),计算单侧颈内动脉血流量与心输出量的比值(Q/CO)。采用受试者工作特征(ROC)曲线分析颈内动脉血流超声参数预测rScO_(2)<60%的准确性。结果 PSV-ICA和rScO_(2) T_(0)、T_(1)和T_(3)时呈正相关(P<0.05),T_(2)时无相关性(P>0.05);EDV-ICA与rScO_(2)各时点无相关性(P>0.05);Q-ICA与rScO_(2)各时点呈正相关(P<0.05);Q/CO与rScO_(2) T_(1)时无相关性(P>0.05),T_(2)和T_(3)时呈正相关(P<0.05)。非CPB期间(T_(0)、T_(1)、T_(3)),PSV-ICA和Q-ICA预测rScO_(2)<60%的截断值分别为51.35 cm/s和283.5 ml/min,灵敏度分别为0.900和0.900,特异度分别为0.610和0.857(AUC=0.761,P=0.006;AUC=0.903,P<0.001);CPB期间,Q-ICA和Q/CO预测rScO_(2)<60%的截断值分别为296.5 ml/min和5.84%,灵敏度分别为0.900和0.800,特异度分别为0.545和0.659(AUC=0.764,P=0.001;AUC=0.748,P=0.002)。结论冠状动脉管路移植术患者非CPB期间,PSV-ICA和Q-ICA与rScO_(2)呈正相关;CPB期间,Q-ICA和Q/CO与rScO_(2)呈正相关。PSV-ICA、Q-ICA和Q/CO可准确预测rScO_(2)<60%。
Objective To evaluate the correlation between ultrasound parameters of internal carotid artery blood flow and regional cerebral oxygen saturation(rScO_(2))in elderly patients undergoing coronary artery bypass grafting(CABG)under cardiopulmonary bypass(CPB).Methods Sixty-four elderly patients undergoing elective CABG under CPB,aged 60-80 yr,regardless of gender,with body mass index of 18.1-28.9 kg/m^(2),of American Society of Anesthesiologists Physical Status classificationⅡorⅢ,with New York Heart Association classⅡorⅢ,with left ventricular ejection fraction≥50%,were selected.The rScO_(2) and ultrasonic parameters of internal carotid artery including peak systolic velocity(PSV-ICA),end-diastolic velocity(EDV-ICA),diameter(D-ICA)and blood flow volume(Q-ICA)were recorded before anesthesia induction(T_(0)),at surgical skin incision(T_(1)),at 30 and 60 min of CPB(mean value was calculated,T_(2)),and at 30 and 60 min after termination of CPB(mean value was calculated,T_(3)).The ratio of unilateral internal carotid artery blood flow to cardiac output(Q/CO)was calculated.The receiver operating characteristic curve was used to analyze the accuracy of ultrasound parameters of internal carotid artery blood flow in predicting rScO_(2)<60%.Results PSV-ICA was positively correlated with rScO_(2) at T_(0),T_(1) and T_(3)(P<0.05),but no correlation was found between PSV-ICA and rScO_(2) at T_(2)(P>0.05).There was no correlation between EDV-ICA and rScO_(2) at each time point(P>0.05).Q-ICA was positively correlated with rScO2 at each time point(P<0.05).Q/CO was not correlated with rScO_(2) at T_(1)(P>0.05),but Q/CO was positively correlated with rScO_(2) at T_(2) and T_(3)(P<0.05).During the non-CPB period(T_(0),T_(1),T_(3)),the cutoff values of PSV-ICA and Q-ICA in predicting rScO2<60%were 51.35 cm/s and 283.5 ml/min respectively,the sensitivity was 0.900 and 0.900 respectively,and the specificity was 0.610 and 0.857 respectively(AUC=0.761,P=0.006;AUC=0.903,P<0.001).During the CPB period,the cutoff values of Q-ICA and Q/CO in predicting rScO_(2)<60%were 296.5 ml/min and 5.84%respectively,the sensitivity was 0.900 and 0.800,and the specificity was 0.545 and 0.659(AUC=0.764,P=0.001;AUC=0.748,P=0.002),respectively.Conclusions PSV-ICA and Q-ICA are positively correlated with rScO_(2) during the non-CPB period,and Q-ICA and Q/CO are positively correlated with rScO_(2) during the CPB period in elderly patients undergoing CABG.PSV-ICA,Q-ICA and Q/CO can accurately predict rScO_(2)<60%.
作者
韩瑛
李宛霖
赵雅梅
魏海燕
尹加林
苏中宏
葛亚力
史宏伟
Han Ying;Li Wanlin;Zhao Yamei;Wei Haiyan;Yin Jialin;Su Zhonghong;Ge Yali;Shi Hongwei(Department of Anesthesiology,Affiliated Children′s Hospital of Jiangnan University(Wuxi Children′s Hospital),Wuxi 214023,China;Department of Anesthesiology,Perioperative and Pain Medicine,Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital),Nanjing 210006,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2024年第2期214-219,共6页
Chinese Journal of Anesthesiology
关键词
心肺转流术
颈内动脉
超声检查
脑
氧
Cardiopulmonary bypass
Carotid artery,internal
Ultrasonography
Brain
Oxygen
