目的:进行了一项单中心前瞻性随机对照研究,以评估靶向轻度高碳酸血症(TMH)对非体外循环冠状动脉旁路移植术(CABG)患者脑氧饱和度(rSO2)的影响。
方法:一项前瞻性随机对照研究,涉及100名在联合国梅塔医院接受非体外循环CABG的患者,Ahmedabad,古吉拉特邦,印度。
方法:患者被随机分为TMH(PaCO245-55mmHg)或目标正常碳酸血症(TN;PaCO235-45mmHg)组,每组50名患者。
方法:监测rSO2、心率、平均动脉压(MAP),在基线时进行PaCO2和外周血氧饱和度,诱导后,左乳内动脉采集后,在每次移植(远端和近端),鱼精蛋白之后,转移到重症监护室后。术前以及拔管后8、12和24小时进行标准化最低状态检查(SMMSE)。数据分析采用独立样本t检验。
结果:TMH组在移植过程中MAP较高(p<0.001),在远端和近端移植过程中(p<0.001)和鱼精蛋白后(p<0.05)两侧rSO2较高,与TN组相比。与术前价值相比,TN组的SMMSE评分在拔管后12小时和24小时显著降低(p<0.001)。
结论:当血流动力学不稳定非常常见时,移植期间的TMH增加了脑血流量和rSO2。它对大脑具有保护作用,并有助于术后维持认知。
OBJECTIVE: A single-center prospective randomized controlled
study was conducted to assess the effect of targeted mild hypercapnia (TMH) on cerebral oxygen saturation (rSO2) in patients undergoing off-pump coronary artery bypass grafting (CABG).
METHODS: A prospective randomized controlled
study involving 100 patients undergoing off-pump CABG at U. N. Mehta Hospital, Ahmedabad, Gujarat, India.
METHODS: Patients were randomized to either the TMH (PaCO2 45-55 mmHg) or the targeted normocapnia (TN; PaCO2 35-45 mmHg) group, containing 50 patients in each group.
METHODS: Monitoring of rSO2, heart rate, mean arterial pressure (MAP), PaCO2, and peripheral oxygen saturation was done at baseline, after induction, after left internal mammary artery harvesting, at each grafting (distal and proximal), after protamine, and after shifting to the intensive care unit. The standardized minimental-state examination (SMMSE) was performed preoperatively and at 8, 12, and 24 hours postextubation. Data were analyzed using an independent sample t test.
RESULTS: The TMH group had higher MAP during grafting (p < 0.001) and higher rSO2 on both sides during distal and proximal grafting (p < 0.001) and after protamine (p < 0.05), as compared to the TN group. Compared to preoperative values, SMMSE scores in the TN group were significantly lower at 12 and 24 hours postextubation (p < 0.001).
CONCLUSIONS: TMH during grafting increased the cerebral blood flow and rSO2 when hemodynamic instability was very common. It has a protective role on the brain and helps maintain cognition postoperatively.