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Objective:To evaluate the value of monitoring regional cerebral oxygen saturation (rSO 2) in the prognosis of comatose children in pediatric intensive care unit (PICU). Methods:A total of 127 coma children who admitted to PICU at Henan Children′s Hospital from January 2019 to September 2021 were collected and divided into mild[Glasgow coma score(GCS): 13-15], moderate(GCS: 9-12) and severe coma(GCS: 3-8) groups according to GCS.A cerebral oxygen monitor was used to monitor the rSO 2 of all children before treatment, and on the 3rd, 7th and 14th day after treatment.The outcomes were assessed according to the pediatric cerebral performance category (PCPC), and the children were divided into recovery group(PCPC score: 1), disability group(PCPC score: 2-4) and poor prognosis group(PCPC score: 5-6). Multiple linear regression and receiver operating characteristic(ROC) curve were used to analyze the correlation between rSO 2 and PCPC score. Results:rSO 2 in mild, moderate and severe coma groups before treatment were (78.06±3.21)%, (66.07±6.05)%, and (52.87±6.49)%, respectively ( F=209.263, P<0.05). rSO 2 before treatment was positively correlated with GCS( r=0.806, P<0.05). There were significant differences in rSO 2 among recovery group, disability group and poor prognosis group before treatment and that on the 3rd, 7th and 14th day after treatment ( P<0.05). Notably, rSO 2 in recovery group was higher than that in disability group, and rSO 2 in disability group was higher than that in poor prognosis group.The rSO 2 of three groups showed an increasing trend over time ( P<0.05). Multiple linear regression analysis showed that rSO 2 on the 7th and 14th day of treatment were independent prognostic factors ( OR -0.042, 95% CI -0.082~0.003, P<0.05; OR -0.047, 95% CI -0.094~0.000, P<0.05). ROC analysis showed that rSO 2 on the 7th day of treatment had a relatively higher prognostic value for children in coma, and the area under the ROC curve for predicting the prognosis of abnormal brain function and no wakefulness were 0.741 and 0.746, respectively. Conclusion:Monitoring rSO 2 has predictive value for the prognosis of brain function of coma children in PICU, in which the prognostic value of rSO 2 on the 7th day after treatment is relatively higher and can be used as a reference index for prognosis assessment of coma children in PICU.
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【Objective】 To investigate the predictive value of regional cerebral oxygen saturation (rScO2) monitoring during total aortic arch replacement and stent trunk surgery for perioperative neurocognitive disorders (PND) and changes in plasma S100β protein and neuron-specific enolase (NSE) concentrations and their relationship with PND. 【Methods】 Sixty-five Stanford type A aortic dissection patients who planned to undergo total aortic arch replacement and trunk stenting were selected. Their rScO2 values were monitored throughout the operation and recorded after induction (T1), the beginning of CPB (T2), during deep hypothermic circulatory arrest (T3), rewarming to 36℃(T4), CPB stop for 1 hour (T5), and post-operation (T6). After induction (Ta), rewarming to 36℃ (Tb),1 h (Tc), 6 h (Td) and 24 h (Te) after cessation of cardiopulmonary bypass, central venous blood was collected from patients, and the concentrations of S100β protein and NSE in plasma were detected by ELISA. The patients were divided into PND group and non-PND group by the evaluation of MMSE scale at time of before operation, on the day of extubation, and 7 days after operation. 【Results】 The incidence of PND was 44.6%. The rScO2 value at T2 was significantly lower than that at T1 (P<0.05). The rScO2 value of PND group at T3 and T6 was significantly lower than that at T1 and non-PND group (P<0.05). The mean value of rScO2 and the minimum value of rScO2 in PND group were significantly lower than those in non-PND group, while rScO2 %max in PND group was significantly higher than that in non-PND group (P<0.05). The intraoperative critical value of rScO2 %max was >9.89%, the area under curve (AUC) was 0.658 (95% CI: 0.525-0.791, P<0.05), and sensitivity and specificity were 48.3% and 75.0%, respectively. The concentrations of S100β protein and NSE protein in PND group were significantly higher than those in non-PND group at Tc and Td (P<0.01). Compared with Ta, the concentration of S100β protein in PND group was significantly increased at Tc and Td (P<0.001), and the concentration of NSE protein was significantly increased at Tb-Te (P<0.01). CPB time was an independent risk factor for PND. 【Conclusion】 The occurrence of PND after total arch replacement and stenting may be related to the decrease of rScO2 and the increase of S100β protein and NSE protein. Intraoperative rScO2 %max >9.89% can be a potential predictor of PND.
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Objective:To explore the correlation between intraoperative regional cerebral oxygen saturation(rScO 2) and nerve damage markers with postoperative neurological dysfunction(PND) in patients undergoing acute Stanford type A aortic dissection surgery. Methods:A total of 57 patients undergoing acute Stanford type A aortic dissection surgery under cardiopulmonary bypass(CPB) in the operating room of Henan Provincial Hospital from July 2020 to May 2021 were enrolled, regardless of gender, aged 35-64 years old, weighed 58.0-90.0 kg and with American Association of Anesthesiologists(ASA) classification status with Ⅱ-Ⅲ. A near infrared spectrometer(NIRS) was used to continuously monitor the bilateral rScO 2 of the patients during the surgery. Central venous blood was drawn 10 min before induction of anesthesia(T0), 10 min after induction of anesthesia(T1), immediately after CPB started(T2), when CPB ended(T3), at the end of the operation(T4), and when exiting ICU(T5), 1 day(T6), 2 days(T7) and 3 days(T8) after operation, and the levels of nerve injury marker S100 calcium binding protein(S100β protein) and neuron-specific enolase(NSE) in serum were measured. Follow up was performed on postoperative 3 to evaluate the occurrence of PND.The value of intraoperative rScO 2 and the concentrations serum S100β protein and NSE were compared between the PND group and the NND(NPND) group. The changes of intraoperative rScO 2 value, the concentrations of serum S100β protein and NSE between the PND group and NPND group were compared. The risk factors of PND and its correlation with the intraoperative rScO 2 value, and the concentrations of serum S100β protein and NSE were analyzed. The prognostic indicators of the two groups of patients were statistically analyzed. Results:Three patients were excluded from the study. A total of 12 patients(22.2%) developed PND(PND group), and 42 patients(77.8%) did not develop PND(NPND group) on postoperative 3 day. Compared with the NPND group, the minimum mean arterial pressure and the minimum rScO 2 during CPB were significantly decreased( P<0.05), the maximum da-rScO 2 during CPB was significantly increased( P<0.05), and duration of da-rScO 2>0.50, duration of da-rScO 2>0.40, duration of rScO 2 reduction >25%, rScO 2<0.50, rScO 2<0.40, during CPB were significantly prolonged( P<0.05) in the PND group. The levels of serum S100β and NSE in the PND group were significantly increased, compared with the NPND group at T2-8, respectively. Logistic regression analysis showed that the reduction of rScO 2 more than 25%( P=0.033), during of rScO 2<0.40( P=0.007) and duration of da-rScO 2>0.50( P=0.001) during CPB were risk factors of PND. Conclusion:Compared with the NPND group, the postoperative mechanical ventilation time, duration of ICU stay, postoperative hospital stay and PND recovery time were significantly prolonged( P<0.05), and the medical expenses were increased significantly( P<0.05) in the PND group. The duration of the reduction of rScO 2>25%, the duration of rScO 2<0.40 and the duration of da-rScO 2>0.50 during CPB are the risk factors of PND in patients with acute Stanford type A aortic dissection under CPB. Significantly increased levels of serum nerve injury markers S100β and NSE are related to the occurrence of PND. The occurrence of PND has a significant adverse effect on the early clinical prognosis of patients.
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Objective:To evaluate the predictive value of regional cerebral oxygen saturation (rScO 2) for the occurrence of sepsis-associated encephalopathy (SAE). Methods:The data of 94 patients with sepsis admitted to the intensive care unit of Nanjing Drum Tower Hospital from September 2019 to June 2021 were collected. The patients were divided into SAE group and non-SAE group according to the evaluation results of daily intensive care unit confusion assessment method (CAM-ICU) during ICU treatment. The general data such as age and gender of the patients, rScO 2 on 1, 2, 3, 5, and 7 days of ICU admission, and prognostics were recorded. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of rScO 2 on SAE during ICU stay. Results:All 94 patients were enrolled in the analysis, of whom 59.6% (56/94) were male, and the mean age was (50.1±15.1) years old; the incidence of SAE was 31.9% (30/94). The levels of rScO 2 within first 3 days of ICU admission in the SAE group were significantly lower than those in the non-SAE group (1 day: 0.601±0.107 vs. 0.675±0.069, 2 days: 0.592±0.090 vs. 0.642±0.129, 3 days: 0.662±0.109 vs. 0.683±0.091, all P < 0.05). However, there was no significant difference in rScO 2 level on the 5th or the 7th day between the SAE and non-SAE groups (5 days: 0.636±0.065 vs. 0.662±0.080, 7 days: 0.662±0.088 vs. 0.690±0.077, both P > 0.05). ROC curve analysis showed that 1-day rScO 2 had the greatest predictive value for SAE [1 day: area under the ROC curve (AUC) = 0.77, 95% confidence interval (95% CI) was 0.65-0.89, P < 0.01; 2 days: AUC = 0.60, 95% CI was 0.48-0.72, P > 0.05; 3 days: AUC = 0.55, 95% CI was 0.41-0.68, P > 0.05]; with 1-day rScO 2 = 0.640 as the diagnostic threshold, the sensitivity was 73.4%, the specificity was 80.0%. Compared with the non-SAE group, the length of ICU stay and hospital stay in the SAE group were significantly longer [length of ICU stay (days): 13.6±7.1 vs. 9.0±4.3, length of hospital stay (days): 20.1±8.0 vs. 15.8±6.1, both P < 0.05], but the ICU mortality between the two groups was not statistically different. Conclusions:The incidence of SAE is relatively high in ICU patients, and the occurrence of SAE can be predicted by monitoring rScO 2. The rScO 2 value on the first day of ICU admission is closely related to the occurrence of SAE, and may be the target of sepsis resuscitation to guide the treatment and improve the long-term prognosis.
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Objective:To evaluate the effect of regional oxygen saturation (rSO 2)-guided low-dose norepinephrine on postoperative cognitive dysfunction (POCD) in elderly patients undergoing hip replacement under general anesthesia. Methods:One hundred and twenty patients of both sexes, aged 65-80 yr, with body mass index of 18-24 kg/m 2, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for hip replacement under general anesthesia, were divided into 2 groups ( n=60 each) using a random number table method: control group (group C) and low-dose norepinephrine guided by rSO 2 group (group RN). The patients in both groups received superior inguinal fascial space block combined with general anesthesia under laryngeal mask placement.In group C, the fluctuation range of mean arterial pressure (MAP) was not more than 20% of the baseline, vasoactive agents were administered according to the changes in blood pressure, rSO 2 was monitored continuously, but the change rate of rSO 2 was not used as the regulating index.In group RN, norepinephrine was infused continuously via the central vein at 0.01-0.10 μg·kg -1·min -1 after anesthesia induction, the dose was adjusted according to rSO 2, the rSO 2 change rate was maintained≤10%, the fluctuation range of mean arterial pressure was not more than 20% of the baseline, and vasoactive agents were administered when necessary.MAP, end-tidal pressure of carbon dioxide (P ETCO 2) and rSO 2 were recorded after inhalation of oxygen (T 0), at 5 min after anesthesia induction (T 1), at 30 min after skin incision (T 2), at the end of surgery (T 3) and after recovery and extubation (T 4), and the change rate of rSO 2 was calculated.The occurrence of adverse events and amount of vasoactive drugs used were recorded.The cognitive function was assessed using Montreal Scale at 1 day before surgery and 7 days after surgery, and the development of postoperative cognitive dysfunction (POCD) was calculated using Z score.The postoperative hospital stay time was recorded. Results:Compared with group C, MAP and rSO 2 were significantly increased, and the change rate of rSO 2 was decreased at T 1, 2 in group RN ( P<0.05). Compared with group C, the requirement for intraoperative vasoactive drugs was significantly decreased, the consumption of norepinephrine was increased, MoCA total score, attention and delayed recall sub-score were increased at 7 days after surgery, the incidence of POCD was decreased, and the postoperative hospital stay time was shortened in group RN ( P<0.05). Conclusion:Low-dose norepinephrine guided by rSO 2 can decrease the development of POCD in elderly patients undergoing hip replacement under general anesthesia.
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Objective:To investigate the application of continuous intracranial pressure (ICP) combined with regional cerebral oxygen saturation (rScO 2) monitoring in patients with hypertensive intracerebral hemorrhage before and after operation of the removal hematoma through small bone window and the effect on the prognosis of patients. Methods:The clinical data of 37 patients with supratentorial hypertensive intracerebral hemorrhage admitted to the neurosurgical intensive care unit of the people′s Hospital of Inner Mongolia Autonomous Region from April 2018 to October 2020 were retrospectively analyzed.ICP monitoring and near infrared spectroscopy (NIRS) were used to monitor the intracranial pressure and rScO 2 concentration before and after the operation, and the changes of intracranial pressure and rScO 2 before and after the operation were analyzed.According to Glasgow Outcome Score (GOS), patients with GOS score>3 were classified as good prognosis group (21 cases), and those with GOS score ≤3 were classified as poor prognosis group (16 cases). Results:The postoperative intracranial pressure((15.80±6.70) mmHg)of patientswith hypertensive intracerebral hemorrhage was lower than that before operation((20.40±5.80) mmHg), and the difference was statistically significant( t=3.226, P=0.002). The postoperative rScO 2 ((62.31±3.85)% )of patientswith hypertensive intracerebral hemorrhage was higher than that before operation((59.73±3.13)%), and the difference was statistically significant( t=3.171, P=0.002). The decrease of intracranial pressure in patients with good prognosis((6.53±2.21) mmHg)was more obvious than that in patients with poor prognosis((4.24±2.30) mmHg). The concentration of rScO 2 increased in both groups.But in the group with good prognosis, the rScO 2 increased((3.99±2.34)%)was significantly higher than that in poor prognosis group((2.32±2.25)%). Six months after operation, there were significant differences in preoperative and postoperative intracranial pressure and rScO 2 between good prognosis group and poor prognosis group, and the difference was statistically significant( t=3.090, 2.176; P=0.004, 0.036). Conclusion:Small bone window evacuation of intracerebral hematoma can significantly reduce the concentration of intracranial pressure and increase the concentration of rScO 2 in patients with intracerebral hemorrhage.The changes of intracranial pressure and rScO 2 before and after operation have potential value in judging the prognosis of patients.
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Objective:To explore the value of regional cerebral oxygen saturation (rScO 2) and anesthesia depth monitoring in predicting postoperative cognitive dysfunction (POCD) in patients with non-macrovascular surgery. Methods:A retrospective analysis of 147 patients with non-macrovascular surgery under general anesthesia admitted to the First Affiliated Hospital of Xi'an Jiaotong University from August 2017 to June 2019 was performed and divided into the POCD group ( n=37) and the non-POCD group ( n=110) according to the presence/absence of postoperative POCD. The changes of bispectral index (BIS) and rScO 2 in patients before anesthesia induction (T 0), endotracheal intubation (T 1), 2 hours after operation (T 2), after operation (T 3), and at extubation (T 4) were recorded, and the predictive value for the occurrence of POCD was analyzed by receiver operating characteristic (ROC) curve. Results:There was no statistically significant difference in anesthesia time, operation time and operation type between the two groups ( P>0.05). There was no significant difference in BIS and rScO 2 levels between the two groups at T 0, T 1 and T 4 ( P>0.05). BIS and rScO 2 levels in the POCD group at T 2 and T 3 were lower than those in the non-POCD ( P<0.05). Both BIS and rScO 2 of the two groups reached the lowest value at T 2, and the reduction rate of rScO 2 in the POCD group was higher than that in the non-POCD group [(31.84±3.27)% vs (14.81±2.52)%, P<0.05]. The ROC curve of BIS-T 2, rScO 2-T 2, BIS-T 3, rScO 2-T 3, rScO 2 reduction from the baseline value to predict POCD in patients with non-macrovascular surgery was plotted, and the AUCs were 0.514, 0.617, 0.505, 0.633, 0.724, respectively. The highest AUC value of 0.808 was found for combined detection at T 2 (rScO 2 and BIS). Conclusions:The combined detection of intraoperative regional cerebral oxygen saturation and anesthesia depth monitoring is of good clinical application value in predicting postoperative cognitive dysfunction in patients with non-macrovascular surgery.
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Objective:To observe the effect of goal-oriented management of continuous monitoring of regional cerebral oxygen saturation (rSO 2) on early postoperative neurocognitive disorders (PND) in elderly spinal surgery patients. Methods:From November 2018 to July 2019, 60 patients undergoing posterior lumbar interbody fusion in the Second Hospital of Shanxi Medical University were selected and randomly divided into control group and intervention group, 30 cases in each group. RSO 2 was recorded before anesthesia induction (T 0), 10 min after anesthesia induction (T 1), 10 min after prone position (T 2), 10 min after spinal decompression (T 3), 30 min after spinal decompression (T 4) and 10 min after extubation (T 5); The basic value of rSO 2, the minimum value of rSO 2 (rSO 2min), the average value of rSO 2 (rSO 2mean) and the maximum percentage of decrease of rSO 2 (rSO 2% max) were recorded. When rSO 2 <55% or rSO 2% max >10% and the duration was longer than 15 s, the intervention group took measures such as adjusting head position, adjusting blood pressure, increasing FiO 2 and respiratory parameters, increasing P ETCO 2 until rSO 2 returned to the required range; The control group did not interfere with the intraoperative rSO 2. Neuropsychological tests were used to evaluate the cognitive function of the two groups 7 days after operation. The patients were followed up 30 days after operation with the revised cognitive function telephone questionnaire (TICS-M). The incidence of postoperative neurocognitive impairment (PND) was recorded. The perioperative data and postoperative adverse reactions of the two groups were recorded. Results:At T 3 and T 4, the rSO 2 of the intervention group was significantly higher than that of the control group ( P<0.01), the intraoperative rSO 2min and rSO 2mean of the intervention group were higher than the control group, and the rSO 2%max was lower than the control group ( P<0.05). The incidence of PND 7 days after surgery, extubation time, postanesthesia care unit (PACU) stay time, hospital stay and postoperative adverse reactions in the intervention group were lower than those in the control group ( P<0.05). There was no significant difference in the incidence of PND 30 days after operation between the two groups ( P>0.05). Conclusions:The goal-oriented management of rSO 2 can reduce the incidence of early postoperative PND in elderly spine surgery patients, which is conducive to the rapid recovery of patients after surgery.
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During the neonatal brain injury, changes in cerebral oxygen saturation precede those in electroencephalogram, nerve function and tissue morphology.The monitoring of cerebral oxygen saturation is an early predictor.Near infrared spectroscopy (NIRS) analysis technology is a non-invasive, continuous, bedside monitoring, safe and feasible tool for monitoring cerebral oxygen saturation.NIRS can be employed to measure the normal value of neonatal cerebral blood volume and cerebral blood flow, and it can be employed for the monitoring of fetal-neonatal transition poor delivery and resuscitation effect, the judgment of hypoxic-ischemic brain injury degree and prognosis, the prediction of intracranial hemorrhage in premature infants, and other usages.Therefore, it is worthy of clinical promotion in neonates.
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OBJECTIVE：To investigate the effects of dexmedetomidine on regional cerebral oxygen saturation and cerebral function in patients undergoing intracranial aneurysm embolization. METHODS ：Totally 44 patients undergoing intracranial aneurysm embolization in the First Affiliated Hospital of Hunan University of TCM during Jun. 2017-Aug. 2019 were collected and randomly divided into group D （22 cases）and group C （22 cases）. Ten minutes before anesthesia induction ，group D was given intravenous injection of Dexmedetomidine hydrochloride injection 1 μg/kg；group C was given buffered normal saline 20 μL. Both groups were induced with Propofol emulsion injection+Midazolam injection+Fentanyl citrate injection+Cisatracurium besylate for injection. During the operation ，group D was given Dexmedetomidine hydrochloride injection 0.5 μg（/ kg·h）+Fentanyl citrate injection+Benzsulfosum atracurium for injection+Propofol emulsion injection to maintain anesthesia ；group C was continuously pumped with buffered normal saline 0.5 μg（/ kg·h）+Fentanyl citrate injection + Benzsulfosum aratracurium for injection Propofol emulsion injection to maintain anesthesia. Before anesthesia induction （T0）， immediately after anesthesia。induction （T1）， 1 min after tracheal intubation （T2）， immediately after operation finished （T3），immediately afte extubation（T4），the mean arterial pressure（MAP），heart rate 中国药房 2021年第32卷第7期 China Pharmacy 2021Vol. 32 No. 7 ·865· （HR），regional cerebral oxygen satur ation（rSO2）were observed in 2 groups. The levels of neuron specific enolase （NSE）and S100 β protein in serum were measured at T1，T3，6 h after operation （T6）. The recovery time ，intraoperative blood loss ， nitroglycerin amount and the occurrence of ADR were recorded. RESULTS ：MAP and HR of group D at T 2-T4 were significantly lower than those at T 0；MAP and HR of group C at T 2-T4 were significantly higher than those at T 0；the group D were significantly lower than the group C at the same period （P＜0.05）；there was no statistical significance in rSO 2 between 2 groups at T 0-T4（P＞ 0.05）. The levels of serum NSE and S 100β protein in 2 groups at T 3 were significantly higher than at T 1；those in 2 groups at T 6 were significantly lower than at T 3，but those of group D were significantly lower than the group C at T 3（P＜0.05）；there was no statistical significance in the levels of serum NSE or S 100β protein between 2 groups at T 1（P＞0.05）. The recovery time of anesthesia，the amount of nitroglycerin ，the incidence of tachycardia ，nausea and vomiting ，restlessness，shivering and cough in group D were significantly shorter or lower than group C （P＜0.05）；there was no statistical significance in the intraoperative blood loss between 2 groups（P＞0.05）. CONCLUSIONS ：Dexmedetomidine can maintain the hemodynamic stability of patients with intracranial aneurysm embolization during the perioperative period ，has little effect on rSO 2 and brain function ，and has good safety.
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OBJECTIVES@#Sepsis associated encephalopathy (SAE) is a common neurological complication of sepsis. Delirium is a common symtom of SAE. The pathophysiology of SAE is still unclear, but several likely mechanisms have been proposed, such as mitochondrial and endothelial dysfunction, neurotransmission disturbances, derangements of calcium homeostasis, cerebral microcirculation dysfunction, and brain hypoperfusion. Near-infrared spectroscopy (NIRS) is a non-invasive measure for regional cerebral oxygen saturation (rSO@*METHODS@#A total of 48 septic patients who admitted to the intensive care unit (ICU) of Xiangya Hospital, Central South University from August 2017 to May 2018, were retrospectively study. Septic shock was diagnosed according to the criteria of sepsis 3.0 defined by the American Association of Critical Care Medicine and the European Society of Critical Care Medicine. NIRS monitoring was performed during the first 6 hours admitted to ICU with sensors placed on the bilateral forehead of patients. The maximum (rSO@*RESULTS@#The overall 28-day mortality of septic shock patients was 47.92% (23/48), and the incidence of delirium was 18.75% (9/48). The rSO@*CONCLUSIONS@#Cerebral anoxia and hyperoxia, as well as the large fluctuation of cerebral oxygen saturation are important factors that affect the outcomes and the incidence of delirium in septic shock patients, which should be paid attention to in clinical practice. Dynamic monitoring of cerebral oxygen saturation and maintain its stability may be of great significance in patients with septic shock.
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Humans , APACHE , Intensive Care Units , Oxygen Saturation , Prognosis , Retrospective Studies , Sepsis , Shock, SepticABSTRACT
Objective:To investigate the value of clinical monitoring of regional cerebral oxygen saturation (SctO2) for severe traumatic brain injury (sTBI). Methods:From December, 2017 to January, 2019, 33 patients with sTBI within 24 hours were monitored SctO2, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) with near-infrared spectroscopyonce per six hours for seven days. They were assessed with Glasgow Coma Score (GCS) at admission and Glasgow Outcome Score (GOS) six months after injury. Results:SctO2 was the lowest on the third day of monitoring, and then increased gradually. SctO2 negatevely correlated with ICP (r < -0.857, P < 0.001), and positively correlated with GCS, CPP and GOS (r > 0.697, P < 0.05). Conclusion:SctO2 monitoring is valuable after sTBI to identify the secondary injuries and severity of injuries, and predict the outcome partly.
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Objectives: To compare regional cerebral tissue oxygen saturation (rScO2) changes during cardiac surgery in children with ventricular septal defect (VSD) and tetralogy of Fallot (TOF). Methods: A total of 60 children aged 3~36 months were enrolled (28 in VSD group 32 in TOF group). rScO2was monitored by Fore-Sight near-infrared spectroscopy device. rScO2, pulse oxygen saturation (SpO2), systolic pressure, diastolic pressure, heart rate, stroke volume index, cardiac index, systemic vascular reststance index the maximal slope of systolic upstroke (dp/dt max) were obtained at following time points: after anesthesia induction (t0), pericardium opening (t1), 5 min after cardiopulmonary bypass (CPB) initiation (t2), 5 min before separation from CPB (t3), separation from CPB (t4), post-modified ultrafiltration (t5), end of surgery (t6). Results: (1) The lowest rScO2value was observed at separation from CPB (t4), and which was significantly lower than that at t0(P<0.05) for both groups; rScO2, stoke volume index, cardiac index, and dp/dt max at t5were significantly higher than at t4(all P<0.001) for both groups. (2) rScO2and SpO2were significantly higher at t5and t6than at t0(both P<0.05) in TOF group. rScO2at t0-t2was significantly lower in TOF group than in VSD group (both P<0.05). rScO2increased more significantly after modified ultrafiltration and rScO2was positively correlated with SpO2at t0and t1(r=0.35, P<0.05 and r=0.64,P<0.01) in TOF group. (3) In the total cohort, rScO2was positively correlated with age, weight at t0, t1, t3, t4, t5, t6(all P<0.01). After modified ultrafiltration, the increase in cardiac index was positively correlated with increase in rScO2(r=0.41, P<0.05), and the amount of cardiac index and rScO2increases were negatively correlated with age (r=-0.30;r=-0.34, both P<0.05). Conclusions: rScO2is closely related with age and weight. Cerebral oxygen delivery before biventricular surgical correction is lower in TOF group than in VSD group, and the cerebral oxygenation improves significantly after surgical repair. Modified ultrafiltration could significantly improve systemic hemodynamics and rScO2, and TOF children and younger children benefit more from modified ultrafiltration. Pre- and post-separation from CPB period is vulnerable to cerebral desaturation, it is therefore of importance to maintain the cerebral oxygen delivery-consumption balance at these periods for children with TOF and VSD undergoing surgical repair.
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Objective To examine the changes of regional cerebral oxygen saturation ( rScO2 ) in children with sepsis via near infrared spectroscopy(NIRS),and to preliminarily explore the clinical signifi-cance of brain oxygenation change in septic children. Methods Children with sepsis who were admitted to Children's Hospital of Fudan University from August 2015 to January 2017 were selected as research objects, according to the presence of septic shock,they were divided into septic shock group and non-shock group. Children without brain damage were selected as the control group and they were healthy before. We prospec-tive monitored the rScO2 of these children after they were admitted to our hospital and recorded the physiolog-ical and biochemical indexes such as mean arterial pressure,heart rate,hemoglobin,lactate and central venous oxygen saturation ( ScvO2 ) simulataneously. We tried to find the changing rule of rScO2 and explore the relationship between rScO2 and related physiological and biochemical indexes as well as the outcome of these children. Results A total of 30 subjects were enrolled into this study, which included 17 septic shock children and 13 non-shock children,17 relatively healthy children were brought into this study as normal con-trol . The rScO2 of septic shock children were lower than those of the non-shock children and the control group in the first 96 hours after admission (P <0. 05). Although the rScO2 were still lower at the time of 144 hours,there were no statistical significance among three groups(P>0. 05). In spite of the rScO2 had no sta-tistical correlation with mean arterial pressure,heart rate,hemoglobin and lactate,there were positive correla-tion between rScO2 and ScvO2 ,the correlation coefficient was about 0. 6 to 0. 7. The higher rScO2 ,the better Glasgow Coma Scale ( GCS) ,which reflected the degree of consciousness. Although the mean rScO2 of the deaths was lower than that of the survivors in septic children,there was no statistical difference. Conclusion The rScO2 of septic shock children is lower than that of non-shock septic children. The rScO2 has no statistical correlation with indicators such as heart rate and mean arterial pressure,but it has strong positive correlation with ScvO2 . Compared with survivors,the rScO2 is lower in dead children. NIRS may be a predictive factor in children with sepsis.
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Objective To observe the clinical efficacy and safety of acute hypervolemic hemodilution (AHH) in combination with controlled hypotension (CH)and autologous blood transfusion (ABT)on spinal surgery. Methods For this study,we enrolled 50 patients undergoing spinal surgery and randomly divided them into two groups.The experimental group received AHH in combination with CH and ABT,while the control group received none of the above treatments.We compared the parameters such as hemodynamics,blood routine and coagulation, the amount of intraoperative bleeding,autologous and allogeneic blood transfusion volume,and regional cerebral oxygen saturation (rSO2)between the two groups.Results In the experimental group CVP increased,while invasive artery blood pressure, HCT, Hb, PLT and the amount of allogeneic blood transfusion decreased significantly compared with those of the control group (P＜0.05).As for the mean intraoperative blood loss, APTT,PT,TT,FIB and rSO2,there were no significant differences between the two groups (P＞0.05). Conclusion AHH in combination with CH and ABT can reduce the amount of allogeneic blood transfusion and has no adverse effect on hemodynamics,blood coagulation or cerebral oxygenation in spinal surgery patients.It is a safe and effective blood protection procedure during spinal surgery.
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Objective To investigate the effects of inverse ratio ventilation on pulmonary function and ce-rebral oxygen saturation in elderly patients with single lung ventilation.Methods Sixty patients scheduled for elec-tive radical resection of esophageal cancer were divided into 2 groups(n=30 for each group)using a random num-ber table:the experiment group(group A)and the control group(group B). During the two lung ventilation,the ventilator parameters were set as tidal volume(VT)7 mL/kg,inspiratory to expiratory ratio 1:2. During one lung ventilation,the I:E ratio was 1.5:1 in the group A and 1:2 in the group B. At 15 min after two lung ventilation (T1),20 min after one lung ventilation(T2),60 min after one lung ventilation(T3)and 15 min after restarting two-lung ventilation(T4),the blood gas analysis was measured and recorded for the hemodynamics,respiratory me-chanics index and cerebral oxygen saturation respectively. Results Compared with the B group,the Ppeak and VD/VT at T2~T4in the group A were lower while PaO2,Pmean and Cdyn were higher(P<0.05).During one lung ventilation,the incidence of rSO2< 50% or rSO2decreased more than 20% in the group A was lower than that in the group B(P<0.05).The PaO2,Cdyn and rSO2of the two groups at T2~T4were significantly lower and Ppeak, Pmean,PaCO2,VD/VT were significantly higher than the baseline(T1)(P < 0.05). Conclusion During one-lung ventilation,prolonged inspiratory time can improve pulmonary function and lung compliance without increas-ing peak airway pressure,reduce the decline of rSO2 at the same time.
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Objective To study the relationship between regional cerebral tissue oxygen saturation (rScO2) and hemodynamic parameters under different end-tidal carbon dioxide partial pressure (PetCO2) levels during anesthesia induction period in children undergoing ventricular septal defect(VSD) repair.Methods A total of 25 patients aged from 2 to 37 months (median 6 months) were enrolled,who received selective VSD repair at Beijing Anzhen Hospital from April to May 2017.After admission,anesthesia induction and intubation,invasive radial artery pressure were established routinely and hemodynamic device-MostCare was used,Fore-Sight was used to monitor rScO2 of the right frontal brain.By means of adjusting mechanical ventilation parameter,PetCO2 was maintained at 30 (T1),35 (T2),40 (T2),45 (T3) mmHg(1 mmHg =0.133 kPa) in sequence.Pulse oxygen saturation (SpO2),heart rate (HR),systolic pressure (SysP),difference between dicrotic pressure (DicP) and diastolic pressure (DiaP) (Pdic-a),stroke volume index (SVI),cardiac index (CI),systemic vascular resistance index (SVRI),and pulse pressure variation (PPV) were recorded at T1,T2,T3 and T4.Results (1) Comparison among groups:rScO2 at T4,T3,T2 and T1 were (80.5 ± 4.0) ％,(78.2 ± 4.6) ％,(74.4 ± 5.7) ％,(70.8 ± 6.5) ％,respectively,rScO2 at T2,T3 and T4 were higher than that at T1,and the differences were statistically significant (all P ＜ 0.05).SysP at T3 [(85 ± 9) mmHg] and T4 [(84 ± 10) mmHg] were lower than that at T1 [(92 ± 15) mmHg],and the differences were statistically significant (all P＜0.05).DicP at T2[(64 ± 12) mmHg],T3[(60 ± 10) mmHg],and T4 [(59 ±9) mmHg] were significantly lower than that at T1 [(68 ± 15) mmHg],and the differences were statistically significant (all P ＜ 0.05).DiaP at T2 [(44 ± 6) mmHg],T3[(41 ±6) mmHg],and T4 [(41 ±6) mmHg]were lower than that at T1 [(47 ±7) mmHg],and the differences were statistically significant(all P ＜ 0.01).SVRI at T4 [(1 382 ± 262) dyne · s cm-5 · m2] was significantly lower than those at T1 [(1 486 ± 241) dyne · s cm-5 · m2],T2 [(1 440 ± 279) dyne · s cm-5 · m2] and T3 [(1 418 ±266) dyne · s cm-5 · m2],and the differences were statistically significant (all P ＜ 0.05).PPV at T3 [(11 ± 4) ％] and T4 [(13 ± 5) ％] was significantly lower than that at T1 [(18 ± 12) ％],and the differences were statistically significant (all P ＜ 0.05).(2) Correlation analysis:in total population,PetCO2 was positively correlated with rScO2 (r =0.582,P ＜ 0.01).At T1,rScO2 was positively correlated with DiaP and DicP (r =0.600,0.658,all P ＜ 0.01),as well as SysP,CI,SVI,Pdic-a (r =0.460,0.424,0.522,0.534,all P ＜ 0.05),rScO2 was negatively correlated with HR and PPV (r =-0.450,-0.490,all P ＜ 0.05).At T2,rScO2 was positively correlated with DiaP and DicP (r =0.689,0.692,all P ＜ 0.01),as well as SysP,SVI (r =0.534,0.445,all P ＜ 0.05).At T3,rScO2 was positively correlated with SysP (r =0.495,P ＜ 0.05),and negatively correlated with PPV (r =-0.562,P ＜ 0.01).At T4,the rScO2 was not correlated with any hemodynamic parameters (P ＞ 0.05).Conclusions During anesthesia induction in ventricular septal defect children,rScO2 increases significantly with the increase in PetCO2.When PetCO2 is at 30 and 35 mmHg,rScO2 is mainly affected by hemodynamics.When PetCO2 is at 40 and 45 mmHg,rScO2 is mainly affected by PetCO2,but less affected by hemodynamics.
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Traumatic brain injury(TBI) can lead to high mortality and disability in children,and can cause great difficulties in treatment worldwide.It is important to prevent and reduce the secondary brain injuries.Therefore,monitoring the brain function,especially the balance of cerebral oxygen metabolism seems to play a very extraordinary role.The mortality and the neurologic sequelae can be improved as long as we detect the cerebral hypoperfusion at the early stage and give timely interventions.Now,the popular monitoring methods include jugular bulb oxygen saturation,regional cerebral oxygen saturation by near infrared spectroscopy,brain tissue oxygen pressure,and cerebral microdialysis.This review aims to summarize the clinical practice of the cerebral oxygen metabolism monitoring methods in TBI children by reviewing the latest research literatures at home and abroad and to provide reference for clinicians to ameliorate the prognosis.
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@#Objective To evaluate the effects of low-dose epinephrine on cerebral oxygen saturation (rScO2) and awakening time during one-lung ventilation (OLV) for thoracic surgery. Methods Thirty consecutive patients undergoing lobectomy from March to July 2016 in our hospital were randomly divided into an epinephrine group (n=15, 8 males and 7 females at an average age of 58.70±11.40 years) or a saline group (n=15, 7 males and 8 females at an average age of 57.00±11.40 years). They were continuously infused with 0.01 μg/(kg·min) epinephrine or saline after general induction. Hemodynamics was maintained ±20% of the baseline value. All patients were ventilated by a pressure control mode during OLV with tidal volume of 5-8 ml/kg and end-tidal carbon dioxide tension (EtCO2) of 35-45 mm Hg. Regional cerebral oxygen saturation (rScO2) was monitored using near-infrared spectroscopy (NIRS) continuously. Results Compared with the saline group, the epinephrine group had a high rScO2 during OLV, with a statisitical significance at OLV 40 min and 50 min (67.76%±4.64% vs. 64.08%±3.07%, P=0.016; 67.25%±4.34% vs. 64.20%±3.37%, P=0.040). In addition, the awakening time of patients in the epinephrine group was shorter than that of the saline group (P=0.004), and the awakening time was associated with the duration of low-dose rScO2 (r=0.374). Conclusion Continuous infusion of 0.01 μg/(kg·min) could improve the rScO2 during OLV and shorten awakening time in thoracic surgery.
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Abstract Background: Despite new improvements on cardiopulmonary resuscitation (CPR), brain damage is very often after resuscitation. Objective: To assess the prognostic value of cerebral oxygen saturation measurement (rSO2) for assessing prognosis on patients after cardiopulmonary resuscitation. Design: Retrospective analysis. Measurements and results: We analyzed 25 post-CPR patients (12 female and 13 male). All the patients were cooled to a target temperature of 33-34 °C. The Glascow Coma Scale (GCS), Corneal Reflexes (CR), Pupillary Reflexes (PR), arterial Base Excess (BE) and rSO2 measurements were taken on admission. The rewarming GCS, CR, PR, BE and rSO2 measurements were made after the patient's temperature reached 36 °C. Results: In survivors, the baseline rSO2 value was 67.5 (46-70) and the percent difference between baseline and rewarming rSO2 value was 0.03 (0.014-0.435). In non-survivors, the baseline rSO2 value was 30 (25-65) and the percent difference between baseline and rewarming rSO2 value was 0.031 (-0.08 to -20). No statistical difference was detected on percent changes between baseline and rewarming values of rSO2. Statistically significant difference was detected between baseline and rewarming GCS groups (p = 0.004). No statistical difference was detected between GCS, CR, PR, BE and rSO2 to determine the prognosis. Conclusion: Despite higher values of rSO2 on survivors than non-survivors, we found no statistically considerable difference between groups on baseline and the rewarming rSO2 values. Since the measurement is simple, and not affected by hypotension and hypothermia, the rSO2 may be a useful predictor for determining the prognosis after CPR.
Resumo Justificativa: Apesar dos novos avanços em reanimação cardiopulmonar (RCP), o dano cerebral muitas vezes ocorre após a reanimação. Objetivo: Avaliar o valor prognóstico de medir a saturação de oxigênio cerebral (rSO2) para estimar o prognóstico em pacientes após a reanimação cardiopulmonar. Projeto: Análise retrospectiva. Medidas e resultados: Foram avaliados após RCP 25 pacientes (12 do sexo feminino e 13 do masculino). Todos os pacientes foram submetidos à hipotermia (temperatura alvo de 33-34 °C). As mensurações da Escala de Coma de Glascow (GCS), dos reflexos corneanos (RC), dos reflexos pupilares (RP) e do excesso de base (EB) e rSO2 foram feitas na admissão. Na hipertermia, as mensurações de GCS, RC, RP, EB e rSO2 foram feitas depois que a temperatura atingiu 36 °C. Resultados: Em sobreviventes, o valor basal de rSO2 foi de 67,5 (46-70) e a diferença percentual entre o valor basal e a hipertermia de rSO2 foi de 0,03 (0,014-0,435). Em não sobreviventes, o valor basal de rSO2 foi de 30 (25-65) e a diferença percentual entre o valor basal de hipotermia de rSO2 foi de 0,031 (-0,08-20). Não houve diferença estatística nas variações percentuais entre os valores da rSO2 na fase basal e de reaquecimento. Uma diferença estatisticamente significativa foi observada entre os valores da GCS na fase basal e de reaquecimento dos grupos (p = 0,004). Não houve diferença estatisticamente significativa entre GCS, RC, RP, EB e rSO2 para determinar o prognóstico. Conclusão: Embora os valores da rSO2 tenham sido mais elevados em sobreviventes do que em não sobreviventes, não observamos uma diferença estatisticamente significativa dos valores da rSO2 entre os grupos na fase basal e de reaquecimento. Como a mensuração é simples, e não afetada por hipotensão e hipotermia, a rSO2 pode ser um indicador útil para determinar o prognóstico após a RCP.