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/m2,ASA分级Ⅱ或Ⅲ级,NYHA分级Ⅱ或Ⅲ级,LVEF≥50％.于麻醉诱导前(T0)、外科切皮(T1)、CPB 30和60 min(取平均值,T2)、停CPB 30和60 min(取平均值,T3)时记录rScO2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rScO2＜60％的准确性.结果 PSV-ICA和rScO2 T0、T1和T3时呈正相关(P＜0.05),T2时无相关性(P＞0.05);EDV-ICA与rScO2各时点无相关性(P＞0.05);Q-ICA 与 rScO2 各时点呈正相关(P＜0.05);Q/CO 与 rSc02 T1时无相关性(P＞0.05),T2 和 T3时呈正相关(P＜0.05).非CPB期间(T0、T1、T3),PSV-ICA和Q-ICA预测rScO2＜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 rScO2＜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rScO2呈正相关;CPB 期间,Q-ICA 和 Q/CO 与 rScO2 呈正相关.PSV-ICA、Q-ICA 和 Q/CO 可准确预测 rScO2＜60％.
Abstract
Objective To evaluate the correlation between ultrasound parameters of internal carotid artery blood flow and regional cerebral oxygen saturation(rScO2)in elderly patients undergoing coronary ar-tery 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/m2,of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ,with New York Heart Association class Ⅱ or Ⅲ,with left ventricular ejection fraction≥50％,were selected.The rScO2 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(T0),at surgical skin incision(T1),at 30 and 60 min of CPB(mean value was calculated,T2),and at 30 and 60 min after termination of CPB(mean value was calculated,T3).The ratio of unilater-al internal carotid artery blood flow to cardiac output(Q/CO)was calculated.The receiver operating charac-teristic curve was used to analyze the accuracy of ultrasound parameters of internal carotid artery blood flow in predicting rScO2＜60％.Results PSV-ICA was positively correlated with rScO2 at T0,T1 and T3(P＜0.05),but no correlation was found between PSV-ICA and rScO2 at T2(P＞0.05).There was no correlation between EDV-ICA and rScO2 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 rScO2 at T,(P＞0.05),but Q/CO was positively correlated with rScO2 at T2 and T3(P＜0.05).During the non-CPB period(T0,T1,T3),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 sensi-tivity 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 predic-ting rScO2＜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.Conclu-sions PSV-ICA and Q-ICA are positively correlated with rScO2 during the non-CPB period,and Q-ICA and Q/CO are positively correlated with rScO2 during the CPB period in elderly patients undergoing CABG.PSV-ICA,Q-ICA and Q/CO can accurately predict rScO2＜60％.
基金项目
国家自然科学基金(81971879)
天津市自然科学基金(17JCYBJC24800)
天津市科技计划重点研发计划科技支撑重点项目(18YFZCSY00560)
NETL
NSTL
万方数据