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首页> 外文期刊>Artificial Organs >Limitations of Current Near‐Infrared Spectroscopy Configuration in Detecting Focal Cerebral Ischemia During Cardiac Surgery: An Observational Case‐Series Study
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Limitations of Current Near‐Infrared Spectroscopy Configuration in Detecting Focal Cerebral Ischemia During Cardiac Surgery: An Observational Case‐Series Study

机译：当前近红外光谱结构在心脏手术期间检测局灶性脑缺血的局限性：观察病例 - 系列研究

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Abstract Cerebral oximetry using near‐infrared spectroscopy (NIRS) allows for continuous monitoring of cerebral perfusion and immediate treatment of hemodynamic perturbations. In configurations used in current clinical practice, NIRS optodes are placed on the patient`s forehead and cerebral oxygen saturation (ScO 2 ) is determined in bilateral frontal cortical samples. However, focal cerebral ischemic lesions outside of the NIRS field of view may remain undetected. The objective of this observational case‐series study was to investigate ScO 2 measurements in patients with acute iatrogenic stroke not located in the frontal cortical region. Adult patients undergoing cardiac surgery with cardiopulmonary bypass or interventional cardiology procedures and suffering stroke in the early postoperative period were identified from the Bernese Stroke Registry and analyzed for their intraoperative ScO 2 values and brain imaging data. Main outcome measures were the ScO 2 values, computed tomography and magnetic resonance imaging findings. In six patients, the infarct areas were localized in the vascular territories of the posterior and/or dorsal middle cerebral arteries. One patient had watershed stroke and another one excellent collaterals resulting in normal cerebral blood volume and only subtle decrease of cerebral blood flow in initially critically perfused watershed brain areas. Intraoperative ScO 2 values were entirely unremarkable or nonindicative for brain damage. Our results indicate that uneventful intraoperative NIRS monitoring does not exclude severe cerebral ischemia due to the limited field of view of commercially available NIRS devices. False negative NIRS may occur as a consequence of stroke localized outside the frontal cortex.
机译：摘要使用近红外光谱（NIRS）的脑血氧滴定法允许连续监测脑灌注和立即治疗血液动力学扰动。在当前临床实践中使用的配置中，将NIRS光学放置在患者的前额和脑氧饱和度（SCO 2）上，在双侧前皮质样品中确定。然而，网址外部视野之外的局灶性脑缺血性病变可能仍未被未被发现。该观察病例系列研究的目的是研究急性科学中风未位于前皮质区域中的患者的SCO 2测量。在术后早期术后期间患有心肺手术或介入心脏病学程序和患有介入心脏手术的成年患者被伯尔尼笔划注册表确定，并分析了他们的术中SCO 2值和脑成像数据。主要结果措施是SCO 2值，计算机断层扫描和磁共振成像结果。在六名患者中，梗塞区域局部化在后/或背侧中脑动脉的血管领土中。一名患者有流域中风，另一种优异的侧支导致正常的脑血容量，并且仅在最初纯粹灌注的流域脑区域中的脑血流量微妙地降低。术中的SCO 2值完全不起眼或不用于脑损伤。我们的研究结果表明，由于市售的NIR器件的有限视野，不平坦的术中NIRS监测不排除严重的脑缺血。由于额外皮质外部局部化的中风，可能发生假阴性鼻腔。

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