体外循环和非体外循环下冠状动脉旁路移植术中 患者脑氧饱和度的变化趋势分析

Variation trend of intraoperative rScO2 in patients with OPCAB and CCABG

摘要:

目的 探讨体外循环和非体外循环下冠状动脉旁路移植术中患者脑氧饱和度（rScO2）的变化趋势。 方法 前瞻性选取2018 年2 月—2019 年6 月在上海市第一人民医院择期行冠状动脉旁路移植术的105 例患 者。其中，56 例接受非体外循环冠状动脉旁路移植术（OPCAB），49 例患者接受体外循环冠状动脉旁路移植 术（CCABG）。术中分别选择T0 ～ T9 10 个时间点检测rScO2，另外记录术后7 d 内术后认知功能障碍（POCD） 发生率。结果 CCABG 组患者手术时间长于OPCAB 组（P <0.05），术中最低鼻咽温和红细胞比容（HCT） 低于OPCAB 组（P <0.05），术中最高血糖（Glu）和血乳酸（Lac）高于OPCAB 组（P <0.05）；但是两组术 中最低rScO2 比较，差异无统计学意义（P >0.05）。两组rScO2 在不同时间、组间、变化趋势上有差别（P <0.05）。 CCABG 组rScO2 与鼻咽温、Lac 呈正相关（r =0.229 和0.283，P =0.005 和0.002），而OPCAB 组rScO2 只 与Lac 呈正相关（r =0.214，P =0.010）。OPCAB 组和CCABG 组POCD 发生率分别为39.29%（22/56）和 32.65%（16/49），且CCABG 组POCD 患者最低rScO2 低于非POCD 患者（P <0.05）。结论 虽然OPCAB 与CCABG 术中患者rScO2 变化趋势有差异，但是rScO2 可能不是影响术后早期POCD 发生的主要原因。

Abstract:

Objective To investigate the variation trend of intraoperative cerebral regional oxygen saturation (rScO2) in patients with off-pump coronary artery bypass (OPCAB) and convention coronary artery bypass grafting (CCABG). Methods A total of 105 patients with cardiac surgery in our hospital were selected from 2018.02 to 2019.06 and divided into OPCAB group (n = 56) and CCABG group (n = 49). Intraoperative rScO2 levels were detected at T0 to T9 time points. The postoperative cognitive dysfunction (POCD) during 5 to 7 d after surgery. Results Compared with OPCAB group, the surgery duration in CCABG group was longer (P < 0.05); intraoperative nasopharyngeal temperature and the lowest hematocrit value (HCT) were lower, and the highest glucose and lactate levels were higher (P < 0.05). But there was no statistical difference of the lowest rScO2 level between OPCAB group and CCABG group (P > 0.05). The rScO2 levels of the two groups among different time points, groups and trends were different (P < 0.05). By Pearson analysis, intraoperative rScO2 level was positive related with nasopharyngeal temperature or serum Lac level in CCABG group (r = 0.229, P = 0.005; r = 0.283,P = 0.002), while intraoperative rScO2 level was only positive related with serum Lac level in OPCAB group (r = 0.214, P = 0.010). The incidence of POCD in OPCAB group and CCABG group were respectively 39.29% (22/56) and 32.65% (16/49), while the lowest rScO2 level of POCD patients in CCABG group was lower than that of patients without POCD (P < 0.05). Conclusion It’s suggested that there would be difference of the variation trend of intraoperative rScO2 between OPCAB and CCABG, but which would be not the main reason for POCD incidence.