Investigation of the Relationship between Cerebral Near-Infrared Spectroscopy Measurements and Cerebrovascular Event in Coronary Artery Bypass Grafting Operation in Patients without Carotid Stenosis and Patients with Carotid Stenosis below Surgical Margins

Abstract Objectives: Stroke is an important cause of mortality and morbidity in surgery. In the present study, we examined the cerebral oximetry values of patients with carotid artery stenosis who did not present surgical indications and those who did not present carotid artery stenosis in coronary artery bypass grafting (CABG) surgery by comparing their cerebral oximetry values with cerebrovascular disease (CVD). Methods: Between January and May 2014, 40 patients who underwent isolated CABG were included in the study. Cerebral oximetry probes were placed prior to induction of anesthesia. Cerebral oximetry values were recorded before induction, in the pump (cardiopulmonary bypass) inlet period, in the post-clamp period, in the pump outlet period, and in the intensive care unit and neurological complications. Results: There was no difference between the groups in terms of demographic data and routine follow-up parameters. Intraoperative surgical data and early postoperative results were similar in both groups. When comparing the groups, there were no statistically significant results in cerebral oximetry values and CVD development. Only one patient in group 2 had postoperative CVD and this patient was discharged from the hospital with right hemiplegia. Mean arterial pressure (MAP)levels were significantly higher in Group 2 (P<0.05). Conclusion: The follow-up of cerebral perfusion with a method like near-infrared spectroscopy (NIRS) will ensure that MAP is adjusted with interventions that will be made according to changes in NIRS. Thus, it will be possible to avoid unnecessary medication and flow-rate increase with cerebral oxygen saturation (rSO2) follow-up.

摘要 研究目的：脑卒中是外科手术中导致患者死亡与致残的重要病因。本研究针对接受冠状动脉旁路移植术（coronary artery bypass grafting, CABG）的患者展开，对比其中无手术指征的颈动脉狭窄（carotid artery stenosis）患者与无颈动脉狭窄患者的脑血氧监测值，并分析其与脑血管疾病（cerebrovascular disease, CVD）的关联。
方法：本研究纳入2014年1月至5月期间接受单纯冠状动脉旁路移植术的40例患者。于麻醉诱导前放置脑血氧监测探头，分别于麻醉诱导前、体外循环（cardiopulmonary bypass, CPB）静脉引流入泵阶段、主动脉阻断后阶段、体外循环泵出阶段，以及重症监护病房阶段记录脑血氧监测值，并同步观察患者的神经系统并发症发生情况。
结果：两组患者的人口学资料与常规随访参数无显著差异。术中手术相关数据与术后早期结局亦无明显区别。组间对比显示，脑血氧监测值与脑血管疾病发生率均无统计学意义上的显著差异。仅第2组有1例患者术后发生脑血管疾病，该患者出院时遗留右侧偏瘫。第2组患者的平均动脉压（mean arterial pressure, MAP）水平显著高于第1组（P<0.05）。
结论：采用近红外光谱法（near-infrared spectroscopy, NIRS）监测脑灌注情况，可根据脑氧饱和度（regional cerebral oxygen saturation, rSO2）的变化采取干预措施调整平均动脉压。通过脑氧饱和度监测，可避免不必要的药物使用与流量调整，优化围手术期脑灌注管理。