PDF(Pubmed)
Abstract：
Literature regarding monitoring and consequences of distal limb ischemia due to femoral artery cannulation for Minimally Invasive Cardiac Surgery (MICS) remains limited. The primary objective was to determine its incidence, defined as a ≥ 15% difference in regional Oxygen Saturation (rSO2) lasting ≥ four consecutive minutes between the cannulated and non-cannulated limb. The secondary objectives included: determination of distal limb ischemia, defined as a Tissue Oxygenation Index (TOI) < 50% in the cannulated limb, identification of predictors for distal limb ischemia, determination of a possible association of NIRS-diagnosed ischemia with acute kidney injury, and the need for vascular surgery up to six months after cardiac surgery. A prospective, observational cohort study with blinded rSO2-measurements to prevent intraoperative clinical decision-making. A single-center, community-hospital, clinical study. All consecutive patients ≥ 18 years old, and scheduled for predefined MICS. Patients underwent MICS with bilateral calf muscle rSO2-measurements conducted by Near-Infrared Spectroscopy (NIRS). In total 75/280 patients (26.79%) experienced distal limb ischemia according to the primary objective, while 18/280 patients (6.42%) experienced distal limb ischemia according to the secondary objective. Multivariate logistic regression showed younger age to be an independent predictor for distal limb ischemia (p = 0.003). None of the patients who suffered intraoperative ischemia required vascular surgery within the follow-up period. The incidence of NIRS-diagnosed ischemia varied from 6.4% to 26.8% depending on the used criteria. Short and long-term vascular sequelae, however, are limited and not intraoperative ischemia related. The added value of intraoperative distal limb NIRS monitoring for vascular reasons seems limited. Future research on femoral artery cannulation in MICS should shift focus to other outcome parameters such as acute kidney injury, postoperative pain or paresthesias.
摘要：
关于在微创心脏手术（MICS）中由股动脉插管引起的远端肢体缺血的监测和后果的文献仍然有限。主要目标是确定其发病率，定义为插管和非插管肢体之间持续≥连续4分钟的局部氧饱和度（rSO2）差异≥15％。次要目标包括：确定远端肢体缺血，定义为插管肢体的组织氧合指数（TOI）<50％，远端肢体缺血预测因子的鉴定，确定NIRS诊断的缺血与急性肾损伤的可能关联，以及心脏手术后六个月内需要进行血管手术。一个潜在的，采用盲法rSO2测量防止术中临床决策的观察性队列研究。单中心,社区医院,临床研究。所有连续患者≥18岁，和预定义的MICS。通过近红外光谱（NIRS）进行双侧小腿肌肉rSO2测量，对患者进行了MICS。根据主要目标，总共有75/280患者（26.79％）经历了远端肢体缺血，而18/280患者（6.42%）根据次要目标经历了远端肢体缺血。多因素logistic回归分析显示年龄较小是远端肢体缺血的独立预测因素(p=0.003)。术中缺血的患者均未在随访期内需要进行血管手术。根据所使用的标准，NIRS诊断的缺血的发生率从6.4％到26.8％不等。短期和长期的血管后遗症，然而,是有限的，与术中缺血无关。由于血管原因，术中远端肢体NIRS监测的附加值似乎有限。未来MICS中股动脉插管的研究应将重点转移到其他结果参数，如急性肾损伤，术后疼痛或感觉异常。
