Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
Evaluation of Cerebral Oxygenation and Tissue Perfusion in Patients Ongoing Coronary Artery Surgery with Cardiopulmonary By-pass
Kardiyopulmoner Baypas ile Koroner Arter Cerrahisi Uygulanan Hastalarda Serebral Oksijenizasyonun ve Doku Perfüzyonunun Değerlendirilmesi
Onur AVCIa, Oğuz GÜNDOĞDUa
aDepartment of Anesthesiology and Reanimation, Sivas Cumhuriyet University Faculty of Medicine, Sivas, TURKEY
Turkiye Klinikleri J Cardiovasc Sci. 2019;31(2):109-15
doi: 10.5336/cardiosci.2019-65779
Article Language: EN
Full Text
ABSTRACT
 Objective: We aimed to determine whether there is a correlation between perfusion parameters [Lactate (lac), venoarterial carbondioxide gradient (ΔpCO2), central venous oxygen saturation (ScVO2)] and the relationship between these parameters and cerebral oxygenation in normothermia (T2), hypothermia (T3) and re-warming (T4) periods in cardiopulmonary bypass procedure (CPB). Material and Methods: Forty patients aged 19-78 years who were scheduled for elective coronary artery bypass surgery were included in the study. Mean arterial pressure (MAP), cerebral oxygenation (rSO2), periferic oxygen saturation (SpO2) values were recorded and by taking blood samples from arterial cannula and central venous catheter simultaneously; hematocrit (Htc), ΔpCO2, lac, ScVO2, actual base excess (aBE), bicarbonate (HCO3) values were recorded in T1 (after anesthesia induction and central venous catheterization), T2 (normothermia, 36oC, at the start of CPB), T3 (hypotermia, 32oC) and in T4 (at the end of CPB, rewarming, 36oC). Results: Between ΔpCO2-lac values, only positive correlation was found in T4 and there was no correlation between them at other times. There was significant negative correlation between rSO2 and lac in T1, T3 and T4, but no significant correlation was found between rSO2-ΔpCO2 parameters at any time. The correlations of lac and ΔpCO2 with cross-clamp and CPB durations were positive, whereas the correlations between ScVO2 and rSO2 with cross-clamp and CPB durations were negative. Conclusion: ΔpCO2 is not an early indicator of hypoperfusion in patients undergoing CPB in accordance with the literature and the lactate level is a guiding parameter in reporting the perfusion status. We recommend the intraoperative use of cerebral oximetry to prevent the brain from being affected by hypoperfusion during CPB and to prevent postoperative neurocognitive disorders in patients.

Keywords: Cardiopulmonary by-pass; cerebral oximeter; perfusion; coronary artery surgery
ÖZET
 Amaç: Çalışmamızda; kardiyopulmoner bypass (KPB) esnasında normotermi, hipotermi ve yeniden ısınma dönemlerinde perfüzyon parametrelerinin [Laktat (Lac), venoarteryel karbondioksit basınç farkı (ΔpCO2), santral venöz oksijen saturasyonu (ScVO2)] kendi aralarında korelasyonunun olup olmadığını ve serebral oksijenizasyon ile ilişkisini ortaya koymayı amaçladık. Gereç ve Yöntemler: Çalışmaya elektif koroner arter by-pass cerrahisi planlanan, 19-78 yaş arası 40 hasta dahil edildi. Anestezi indüksiyonu sonrası santral ven kateteri takıldıktan sonra (T1), KPB başlangıcında normotermi (36oC) döneminde (T2), KPB hipotermi (32oC) döneminde (T3) ve KPB sonu yeniden ısınma (36oC) döneminde (T4) hastanın ortalama arteryel basınç (OAB), serebral oksijenizasyon (rSO2) değerleri ile hastanın arteryel kanülünden ve santral ven kateterinden eş zamanlı alınan kan gazı örneklerinden ortalama periferik oksijen saturasyonu (SpO2), hematokrit (Htc), venöz ve ΔpCO2, lac, ScVO2, aktüel baz açığı (aBE), bikarbonat (HCO3) değerleri kaydedildi. Bulgular: ΔpCO2-lac değerleri arasında sadece T4'de pozitif yönlü korelasyon varken diğer zamanlarda aralarında korelasyon bulunmadı. rSO2-lac arasında T1, T3 ve T4'de negatif yönlü korelasyon anlamlı bulunurken, rSO2-ΔpCO2 parametreleri arasında ise zamanların hiçbirinde anlamlı korelasyon bulunmadı. Lac ve ΔpCO2'nin kross-klemp süresi ve KPB süresi ile korelasyonları pozitif yönlü iken, ScVO2 ve rSO2'nin kross-klemp ve KPB süreleri ile arasındaki korelasyonlar negatif yönlü bulunmuştur. Sonuç: ΔpCO2'nin, literatürle uyumlu olarak, KPB uygulanan hastalarda hipoperfüzyonun bir erken belirteci olmadığı ve laktat düzeyinin perfüzyon durumunu bildirmede yol gösterici bir parametre olduğu kanaatindeyiz. Beynin KPB esnasındaki hipoperfüzyondan etkilenmemesi için ve hastalarda postoperatif nörokognitif bozukluklar gelişmemesi için intraoperatif serebral oksimetre kullanımını önermekteyiz.

Anahtar Kelimeler: Kardiyopulmoner bypass; serebral oksimetre; perfüzyon; koroner arter cerrahisi
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