Abstract：
OBJECTIVE: This study aims to analyze the risk factors for early postoperative brain injury in patients undergoing cardiovascular surgery and explore the predictive value of transcranial color Doppler (TCCD) and regional cerebral oxygen saturation (rSO2) for detecting early postoperative brain injury in cardiovascular surgery patients.
METHODS: A total of 55 patients undergoing cardiovascular surgery with cardiopulmonary bypass in Changzhou No.2 The People\'s Hospital of Nanjing Medical University were included in this study. Neuron-specific enolase (NSE) concentration was measured 24 h after operation. Patients were divided into brain injury (NSE ≥ 16.3 ng/mL) and normal (0 < NSE < 16.3 ng/mL) groups according to the measured NSE concentration. The clinical outcomes between the two groups were compared, including decreased rSO2 and cerebral blood flow (as measured by TCCD) levels. The risk factors of early postoperative brain injury were analyzed by multivariate logistic regression analysis, and the significant variables were analyzed by receiver operating characteristic (ROC) analysis.
RESULTS: A total of 50 patients were included in this study, with 20 patients in the brain injury group and 30 patients in the normal group. Cardiopulmonary bypass time (min) (107 ± 29 vs. 90 ± 28, P = 0.047) and aortic occlusion time (min) (111 (IQR 81-127) vs. 87 (IQR 72-116), P = 0.010) were significantly longer in the brain injury group than in the normal group. Patients in the brain injury group had greater decreased rSO2 (%) (27.0 ± 7.3 vs. 17.5 ± 6.1, P < 0.001) and cerebral blood flow (%) (44.9 (IQR 37.8-69.2) vs. 29.1 (IQR 12.0-48.2), P = 0.004) levels. Multivariate logistic regression analysis suggested that decreased rSO2 and cerebral blood flow levels, aortic occlusion time, and history of atrial fibrillation were independent risk factors for early postoperative brain injury (P < 0.05). ROC analysis reported that the best cutoff values for predicting early postoperative brain injury were 21.4% and 37.4% for decreased rSO2 and cerebral blood flow levels, respectively (P < 0.05).
CONCLUSIONS: The decreased rSO2 and cerebral blood flow levels, aorta occlusion time, and history of atrial fibrillation were independent risk factors for early postoperative brain injury. TCCD and rSO2 could effectively monitor brain metabolism and cerebral blood flow and predict early postoperative brain injury.
METHODS: A total of 55 patients undergoing cardiovascular surgery with cardiopulmonary bypass in Changzhou No.2 The People\'s Hospital of Nanjing Medical University were included in this study. Neuron-specific enolase (NSE) concentration was measured 24 h after operation. Patients were divided into brain injury (NSE ≥ 16.3 ng/mL) and normal (0 < NSE < 16.3 ng/mL) groups according to the measured NSE concentration. The clinical outcomes between the two groups were compared, including decreased rSO2 and cerebral blood flow (as measured by TCCD) levels. The risk factors of early postoperative brain injury were analyzed by multivariate logistic regression analysis, and the significant variables were analyzed by receiver operating characteristic (ROC) analysis.
RESULTS: A total of 50 patients were included in this study, with 20 patients in the brain injury group and 30 patients in the normal group. Cardiopulmonary bypass time (min) (107 ± 29 vs. 90 ± 28, P = 0.047) and aortic occlusion time (min) (111 (IQR 81-127) vs. 87 (IQR 72-116), P = 0.010) were significantly longer in the brain injury group than in the normal group. Patients in the brain injury group had greater decreased rSO2 (%) (27.0 ± 7.3 vs. 17.5 ± 6.1, P < 0.001) and cerebral blood flow (%) (44.9 (IQR 37.8-69.2) vs. 29.1 (IQR 12.0-48.2), P = 0.004) levels. Multivariate logistic regression analysis suggested that decreased rSO2 and cerebral blood flow levels, aortic occlusion time, and history of atrial fibrillation were independent risk factors for early postoperative brain injury (P < 0.05). ROC analysis reported that the best cutoff values for predicting early postoperative brain injury were 21.4% and 37.4% for decreased rSO2 and cerebral blood flow levels, respectively (P < 0.05).
CONCLUSIONS: The decreased rSO2 and cerebral blood flow levels, aorta occlusion time, and history of atrial fibrillation were independent risk factors for early postoperative brain injury. TCCD and rSO2 could effectively monitor brain metabolism and cerebral blood flow and predict early postoperative brain injury.
摘要：
目的：本研究旨在分析心血管手术患者术后早期脑损伤的危险因素，探讨经颅彩色多普勒超声（TCCD）和局部脑氧饱和度（rSO2）对心血管手术患者术后早期脑损伤的预测价值。
方法：以南京医科大学附属常州第二人民医院55例体外循环心血管手术患者为研究对象。术后24h测定神经元特异性烯醇化酶(NSE)浓度。根据测得的NSE浓度将患者分为脑损伤组(NSE≥16.3ng/mL)和正常组(0结果：本研究共纳入50例患者，脑损伤组20例，正常组30例。体外循环时间(min)(107±29vs.90±28，P=0.047）和主动脉闭塞时间（min）（111（IQR81-127）vs.87（IQR72-116），P=0.010），脑损伤组明显长于正常组。脑损伤组患者的rSO2（％）降低更大（27.0±7.3vs.17.5±6.1，P<0.001）和脑血流量（％）（44.9（IQR37.8-69.2）与29.1（IQR12.0-48.2），P=0.004）水平。多因素logistic回归分析提示rSO2和脑血流量水平下降,主动脉闭塞时间,房颤病史是术后早期脑损伤的独立危险因素(P<0.05)。ROC分析报告，预测术后早期脑损伤的最佳临界值为21.4％和37.4％的rSO2和脑血流量水平下降，分别为(P<0.05)。
结论：rSO2和脑血流量水平降低，主动脉闭塞时间,房颤病史是术后早期脑损伤的独立危险因素。TCCD和rSO2可以有效监测脑代谢和脑血流量，预测术后早期脑损伤。
方法：以南京医科大学附属常州第二人民医院55例体外循环心血管手术患者为研究对象。术后24h测定神经元特异性烯醇化酶(NSE)浓度。根据测得的NSE浓度将患者分为脑损伤组(NSE≥16.3ng/mL)和正常组(0
结论：rSO2和脑血流量水平降低，主动脉闭塞时间,房颤病史是术后早期脑损伤的独立危险因素。TCCD和rSO2可以有效监测脑代谢和脑血流量，预测术后早期脑损伤。
