北京生物医学工程

脑血红蛋白浓度指数在体外循环中的应用

JIA Zaishen, TENG Yichao, LI Yue, XIE Haixiu, LIU Yuan, HOU Xiaotong

作者：贾在申腾轶超李岳谢海秀刘媛侯晓彤

单位：                      首都医科大学附属北京安贞医院，北京市心肺血管疾病研究所，心脏外科危重症中心，体外循环及机械循环辅助科(北京100029)        

关键词：脑；血红蛋白浓度指数；近红外光谱；体外循环；改良超滤

分类号：

出版年·卷·期（页码）：2014·33·3（300-305）

摘要：

目的基于稳态的近红外光谱技术，可无创、实时监测脑组织血红蛋白浓度指数，以反映人体脑组织中
血红蛋白总浓度变化的百分比，从而有利于评价脑血流动力学及脑氧合。方法基于稳态近红外光在人体脑
组织中的传播规律研发了近红外组织血氧检测仪，并用其无创、实时监测了8例经受体外循环手术的先天性
心脏病婴儿的脑组织血红蛋白浓度指数及脑组织氧饱和度。结果在体外循环末期的改良超滤阶段，所有婴
儿的脑组织血红蛋白浓度指数均显著上升，上升速率为(0.0304±0.0136) mM/(cm·min)，P<0.001。改良超
滤结束与起始时相比，脑血红蛋白浓度指数增加了(18.8±7.5)%，这是由于改良超滤提高了血液的红细胞容
积比。此过程中脑组织氧饱和度平均增加了(5.3±4.1)个百分点(P<0.05)，但不如脑血红蛋白浓度指数的上
升趋势明显。结论在体外循环手术的改良超滤过程中，脑组织血红蛋白浓度指数可有效反映脑组织血流动
力学与氧合的变化。

Objective Using continuous-wave near infrared spectroscopy (NIRS), human cerebral
tissue hemoglobin concentration index (tHI) is detected non-invasively and in real time, so
that the change percentage of cerebral total hemoglobin concentration can be indicated and
cerebral hemodynamics as well as oxygenation can be evaluated. Methods Based on the
propagation of near-infrared light in human brain, the near-infrared oximeter was developed,
and the cerebral tHI as well as cerebral oxygen saturation of 8 infants suffered from
congenital heart disease were monitored non-invasively and in real time under cardiopulmonary
bypass. Results During modified ultrapurification in the end of cardiopulmonary bypass, the
cerebral tHI of all the infants increased significantly at the average speed of (0.0304±
0.0136) mM/(cm?min), P<0.001. Comparing the end to the beginning of modified
ultrapurification, the cerebral tHI increased for (18.8±7.5) %, because the hematocrit was
increased by filtering out the redundant water in the blood. The cerebral oxygen saturation
increased for (5.3±4.1) % (P<0.05), which was not so obvious as the increase trend of
cerebral tHI. Conclusions During modified ultrapurification in the end of cardiopulmonary
bypass, the changes of cerebral hemodynamics and oxygenation may be indicated effectively by
cerebral tHI.

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