Objectives:We investigated whether the selective cerebral perfusion(SCP)technique causes differences in changes in cerebral perfusion between both hemispheres in young infants,using cerebral oxygen saturation(ScO2)as ...Objectives:We investigated whether the selective cerebral perfusion(SCP)technique causes differences in changes in cerebral perfusion between both hemispheres in young infants,using cerebral oxygen saturation(ScO2)as an index.Further,we determined the association between the discrepancy in ScO2 and cerebral perfu-sion pressure during SCP.Methods:The difference in ScO2 between the left and right cerebral hemispheres(ΔScO2 Rt-Lt)was calculated during clamping of the innominate artery(IA)and during SCP.Results:In 25 infants(aged 2 to 78 days),the left and right ScO2 were well maintained(median 63.2%and 60.9%during IA clamping,respectively;64.0%and 65.6%during SCP,respectively).During IA clamping,right and left ScO2 decreased(med-ian-1.4%and-1.0%,respectively).During SCP,rightΔScO2 was higher compared to leftΔScO2(median 1.5%vs.0.6%;p<0.001).Eight patients had a higher rightΔScO2 than leftΔScO2 throughout SCP.They had lowerΔScO2 Rt-Lt during IA clamping(median-3.2%vs.0.0%;p<0.001)and higherΔScO2 Rt-Lt during SCP than others(median 5.0%vs.-0.8%;p<0.001).During and after SCP,the correlation coefficient between rightΔScO2 and change in the mean arterial pressure was higher in patients with a discrepancy than in others(r=0.731 vs.r=0.519;p<0.001).Conclusions:This study suggests that SCP permits adequate bilateral cerebral perfusion.However,the unilateral cerebral perfusion technique may cause a difference in cerebral perfusion between both hemispheres in young infants;this may depend on the perfusion pressure.展开更多
Background:In patients with cyanotic congenital heart disease(CHD),cerebral oxygenation may be maintained by elevations in hematocrit(Hct).Hemodilution accompanying cardiopulmonary bypass(CPB),however,can disrupt cere...Background:In patients with cyanotic congenital heart disease(CHD),cerebral oxygenation may be maintained by elevations in hematocrit(Hct).Hemodilution accompanying cardiopulmonary bypass(CPB),however,can disrupt cerebral oxygen balance,leading to fluctuations in cerebral oxygen saturation(ScO_(2)).The present study investigated the effects of Hct changes on the fluctuation of ScO_(2)during CPB in cyanotic CHD using performance measurement(PM).Methods:Children with CHD(51 acyanotic and 46 cyanotic)who had undergone cardiac surgery using CPB were enrolled.Median performance error(MDPE),median absolute performance error(MDAPE),and wobble parameters of ScO_(2)were calculated before(reference value),during,and after CPB.Correlations of PM parameters with Hct and reductions in Hct(ΔHct)were also evaluated.Results:Before CPB,patients with cyanotic CHD had lower MDPE and larger wobble than those with acyanotic CHD,although mean ScO_(2)did not differ significantly between the two groups.During CPB,ScO_(2)of acyanotic CHD increased asΔHct increased,but PM variables were not associated withΔHct.In cyanotic CHD,MDPE(r=−0.324,p=0.032)and MDAPE(r=0.339,p=0.024)correlated significantly withΔHct during CPB.After CPB,MDPE(r=0.574,p=0.025)and MDAPE(r=−0.543,p=0.036)were significantly correlated with Hct in children with cyanotic CHD who underwent palliative surgery.Conclusion:Therefore,ScO_(2)fluctuation during CPB in children with cyanotic CHD may be affected by the decrease in Hct,suggesting that excessive hemodilution can negatively influence the maintenance of cerebral oxygenation in these patients.展开更多
基金supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute,funded by the Ministry of Health&Welfare of the Republic of Korea(HI18C2383).
文摘Objectives:We investigated whether the selective cerebral perfusion(SCP)technique causes differences in changes in cerebral perfusion between both hemispheres in young infants,using cerebral oxygen saturation(ScO2)as an index.Further,we determined the association between the discrepancy in ScO2 and cerebral perfu-sion pressure during SCP.Methods:The difference in ScO2 between the left and right cerebral hemispheres(ΔScO2 Rt-Lt)was calculated during clamping of the innominate artery(IA)and during SCP.Results:In 25 infants(aged 2 to 78 days),the left and right ScO2 were well maintained(median 63.2%and 60.9%during IA clamping,respectively;64.0%and 65.6%during SCP,respectively).During IA clamping,right and left ScO2 decreased(med-ian-1.4%and-1.0%,respectively).During SCP,rightΔScO2 was higher compared to leftΔScO2(median 1.5%vs.0.6%;p<0.001).Eight patients had a higher rightΔScO2 than leftΔScO2 throughout SCP.They had lowerΔScO2 Rt-Lt during IA clamping(median-3.2%vs.0.0%;p<0.001)and higherΔScO2 Rt-Lt during SCP than others(median 5.0%vs.-0.8%;p<0.001).During and after SCP,the correlation coefficient between rightΔScO2 and change in the mean arterial pressure was higher in patients with a discrepancy than in others(r=0.731 vs.r=0.519;p<0.001).Conclusions:This study suggests that SCP permits adequate bilateral cerebral perfusion.However,the unilateral cerebral perfusion technique may cause a difference in cerebral perfusion between both hemispheres in young infants;this may depend on the perfusion pressure.
文摘Background:In patients with cyanotic congenital heart disease(CHD),cerebral oxygenation may be maintained by elevations in hematocrit(Hct).Hemodilution accompanying cardiopulmonary bypass(CPB),however,can disrupt cerebral oxygen balance,leading to fluctuations in cerebral oxygen saturation(ScO_(2)).The present study investigated the effects of Hct changes on the fluctuation of ScO_(2)during CPB in cyanotic CHD using performance measurement(PM).Methods:Children with CHD(51 acyanotic and 46 cyanotic)who had undergone cardiac surgery using CPB were enrolled.Median performance error(MDPE),median absolute performance error(MDAPE),and wobble parameters of ScO_(2)were calculated before(reference value),during,and after CPB.Correlations of PM parameters with Hct and reductions in Hct(ΔHct)were also evaluated.Results:Before CPB,patients with cyanotic CHD had lower MDPE and larger wobble than those with acyanotic CHD,although mean ScO_(2)did not differ significantly between the two groups.During CPB,ScO_(2)of acyanotic CHD increased asΔHct increased,but PM variables were not associated withΔHct.In cyanotic CHD,MDPE(r=−0.324,p=0.032)and MDAPE(r=0.339,p=0.024)correlated significantly withΔHct during CPB.After CPB,MDPE(r=0.574,p=0.025)and MDAPE(r=−0.543,p=0.036)were significantly correlated with Hct in children with cyanotic CHD who underwent palliative surgery.Conclusion:Therefore,ScO_(2)fluctuation during CPB in children with cyanotic CHD may be affected by the decrease in Hct,suggesting that excessive hemodilution can negatively influence the maintenance of cerebral oxygenation in these patients.
