麻醉監測||腦(nǎo)外(wài)污染對(duì)局部腦(nǎo)血氧飽和∑Ω↕φ(hé)度監測的(de)影(yǐng)響

麻醉監測||腦(nǎo)外(wài)污染對(duì)局部腦(nǎo)血氧飽和(hé)度監測的(de)影(yǐng)響(圖1)

摘要(yào)譯文(wén)（供參考）

器(qì)官捐獻期間(jiān)揭示的(de)α✔腦(nǎo)外(wài)污染對(duì)近(jìn)紅(hóng)外(wài)光(guāng)譜的(de)影(yǐng)響：腦(nǎo)λ"死亡器(qì)官捐獻者的(de)前瞻性觀察研‍✔ ★究

背景：

近(jìn)紅(hóng)外(wài)光(guāng)譜（Near-infr×•§ared spectroscopy ，NI₽≥¶RS）已廣泛用(yòng)于麻醉和(hé)重症監護，以監測局≠§∏部腦(nǎo)血氧飽和(hé)度（regional
cerebral oxygen saturation，r& ScO2）。腦(nǎo)外(wài)組織的(de)正常氧合可(→βkě)能(néng)會(huì)覆蓋并掩蓋腦(nǎo)飽和(hé)度↔ 下(xià)降，這(zhè)種現(xiàn)象稱為(wèi)腦(nǎλ≈↕o)外(wài)污染。我們研究了(le)停止腦(nǎo)外(wài)組織灌注對(duì)腦(nǎo)↑$∑•缺氧患者 rScO2 的(de)影(yǐng)響。

方法：

在一(yī)項單中心、前瞻性、觀察性研究中，對(du♦£≥ì)接受器(qì)官捐獻的(de)腦(nǎo)死亡成÷€年(nián)人(rén)進行(xíng)了ε•©≤(le)調查。使用(yòng) INVOS 5100c€✔♠π/7100 和(hé) ForeSight ↓★‌∑Elite 系統同時(shí)測量 rSc♠×&♥O2。為(wèi)了(le)實現(xiàn)器(qì)官的(>γ₹∞de)有(yǒu)效保護并防止灌注液重新分(fēn)布‍>↔β到(dào)其他(tā)組織，在器(qì)官灌注之前夾緊主動脈。監測 rScO2 直到(dào)主動脈鉗夾後至少(shǎo‍≤ ) 40 分(fēn)鐘(zhōng)。主要(yào☆ ✘€)結局指标是(shì)通(tōng)過主動脈鉗夾後rScOγ§2絕對(duì)值降低(dī)來(lái)量化(huà)的(de)↔επ腦(nǎo)外(wài)污染量。次要(yào)結局指标是(shì÷→)鉗夾前後獲得(de)的(de)rScO2絕對(duì)≤♣≥"值。

結果：

包括12名器(qì)官捐獻者。将INVOS（43.0 ± 9.5%）與&nbs↕β≥±p;ForeSight
（p<0.001）。在主動脈鉗夾之∑§₩前，INVOS（63.8±6.2%）和(hé)ForeSight監測儀（67→φ.7±6.5%）獲得(de)了(le)接近(jìn)正常的(de♦♠®)rScO2值。夾閉30分(fēn)鐘(zhōng)後，rScO2✘↓'顯著下(xià)降（p<0.001）至20.8%±7♥₩™✔.8%（INVOS）和(hé)39.9±8.1%（For "₽eSight），即腦(nǎo)外(wài)組÷'ε<織和(hé)腦(nǎo)組織均去(qù)飽和(hé)。（27.8 ± 7.1%）監測儀進行(xíng)比較≈÷時(shí)，主動脈鉗夾導緻 rScO2 的(de)絕對(duì)值顯著降低★₽(dī)

結論：

由主動脈鉗夾引起的(de)腦(nǎo)外(wài)污染的(de)突然結束，§φ✔在相(xiàng)當大(dà)的(de)程度上(shà★" ±ng)影(yǐng)響了(le)兩台近(jìn)紅÷'∞±(hóng)外(wài)監測儀。INVOS和(hé)For≥✔¥↑eSight監測器(qì)都(dōu)無法檢測到(dào)在正常腦(n±∏&ǎo)外(wài)氧合條件(jiàn)下(xià)的(de)嚴重腦(nǎo≠βφ±)缺氧/缺氧。雖然這(zhè)兩種近(jìn)紅(hóng)外☆∑←(wài)監測儀都(dōu)可(kě)以指導優化(huà)頭部動脈供απ氧的(de)措施，但(dàn)不(bù)應将其用(y >òng)于檢測孤立的(de)腦(nǎo)血飽和(hé)↕₽α度下(xià)降。

原文(wén)摘要(yào)

The effect of extracerebral co¥‍±εntamination on near infrared spectr γoscopy as revealed during organ do∞✘•nation: A prospective observatio ®σαnal study in brain dead organ do×≤•∞nors

Abstract

Background:Near-infrared spectro¥$scopy (NIRS) has bee∑‌n utilized widely in anesthesia and ♣¶≠"intensive care to monitor region↕§ al cerebral oxygen saturation (rSc ∏↕₩O2). A normal oxygenation of extracere★ε bral tissues may overl"↕↕ay and thereby mask cΩ&erebral desaturations₩‍✔, a phenomenon known as extraceδσrebral contamination. We investigated₩₽σ the effect of a cessation±↔☆™ of extracerebral tissue ≥∑←perfusion on rScO2 in patients with ±₹♠∞anoxic brains.

Methods:In a single-center, pro‍π‌spective, observational study, brainδ™'✘ dead adults undergoing organ donatβ↓γσion were investigated. rS$γβcO2 was measured bifrontallyσ↕ using the INVOS 5100β₹✘€c/7100 as well as the ForeSight Elite sys™Ωtem. To achieve an ef§∑↓ficient conservation of organs and t©<α∞o prevent a redistribution of the™∑ perfusion fluid to other tis♥sues, the aorta was clamped prio♥<δ r to organ perfusion. rScO2 wasβ≈÷↕ monitored until at least forty min∞ utes after aortic clampingΩ£&. The primary outcome was the amount oφ<φ f extracerebral contami∞δ♥εnation as quantified ©®£by the absolute decrease in ©®>rScO2 after aortic clamping. Se&λ≥condary outcomes were the absol ✘£★ute rScO2-values obtained before and afπ™&☆ter clamping.

Results:Twelve organ donors were included. δ≠Aortic clamping resulted in a signific→×™♦antly (p<0.001) grea✘✔ter absolute decrease in rS&>cO2 when comparing the INVOS (43.<€Ω0 ± 9.5%) to the ForeSight (27.8®π‌♦ ± 7.1%) monitor. Before ao₩β€rtic clamping, near normal rScO2-valu'©®★es were obtained by th β✘↑e INVOS (63.8 ± 6.2%)±φ♦✔ and the ForeSight-monitorδΩ★✔ (67.7 ± 6 .5%). Theσ¶™ rScO2 significantly (p<0.001'∞∞♦) dropped to 20.8 ± 7.8% (INVO★☆S) and 39.9 ± 8.1% (ForeSight) thir ®™ty minutes after clamping, i.e. a &♥condition of a desaturation of both e£→xtracerebral and cereb∑<☆ ral tissues.

Conclusions:The abrupt end of extr↑∏>πacerebral contaminatiφ★↑on, caused by aortic ≥¥≤γclamping, affected both NIRS monitoλ∞rs to a considerable extent. Both th♦‍e INVOS and the ForeS→♥♥←ight-monitor were unable to detect seve₹↓÷→re cerebral hypoxia/anoxia und☆¶er conditions of normal extra♣≈cerebral oxygenation. Whi∑∏"le both NIRS-monitors may© guide measures to o↔↓ptimize arterial oxygen suφ×∑Ωpply to the head, they sho ∑✔uld not be used with the intention to ↕ ↑ detect isolated cere¥≠♦₽bral desaturations.

麻醉監測||腦(nǎo)外(wài)污染對(duì)局部腦(nǎo)血氧飽和(hé)度監測的(de)影(yǐng)響(圖2)