Cerebral Oxygen Saturation Monitoring Predicts Cerebral Hyperperfusion In Patients With Moyamoya Disease After Bypass

ObjectiveUsing a case-control study,grouping according to whether overperfusion has occurred:Cassetting the changes pre-and post-operative in the value of cerebral oxygen saturation(rSO2)and mean arterial pressure(MAP)of the patients with moyamoya disease underwent superficial temporal artery(STA)-middle cerebral artery bypass(MCA),cassetting the amount of norepinephrine throughout the perioperative period and the total operation time.The incidence of postoperative facial and eye pain,seizures,headache and/or focal neurological signs was cassetted.Cassetting the postoperative follow-up brain CT changes(whether there is diffuse or flaky white matter edema on the operating side,whether there is a space-occupying effect on the operating side,whether there is shallowing of the sulcus on the operating side,and/or whether there is intracranial hemorrhage on the operating side),and cassetting the total days of hospitalization of the patients.Probing the origin of cerebral hyperperfusion after moyamoya disease superficial temporal artery-middle cerebral artery bypass surgery,in order to further provide new monitoring indicators and intervention measures for the occurrence of cerebral hyperperfusion after moyamoya disease bypass.MethodsSixty-six patients with moyamoya disease were picked for elective superficial temporal artery-middle cerebral artery bypass surgery under general anesthesia.Quering the patient’s age,sex,body mass index(BMI)and cassetting it;Quering whether cerebral infarction taken place in the past month,hypertension and(or)diabetes and cassetting it.After the patient entered the operating room,two venous accesses will be opened through the lower limbs after the tripartite verification.Pulse oxygen saturation(SpO2),non-invasive blood pressure(NIBP)and electrocardiogram(ECG)were continuously monitored.Radial artery puncturing and catheter placement is under local anesthesia to monitor arterial blood pressure(ABP).After alcohol degreasing in front of the forehead,place 1cm on the side of the affected side of the forehead and 1-2cm on the brow arch to paste the electrode of the adult brain oxygen saturation monitor and connect the 5100C brain oxygen saturation monitor to monitor the bilateral local brain oxygen saturation(rSO2),to ensure that the paste is tight and prevent the influence of gas and other factors.Recording the patient’s rSO2,heart rate(HR)and mean arterial pressure(MAP)before operation(T0),the first day after surgery(T1),and the fourth day after surgery(T2).Recording whether the patient has headache,facial and eye pain,seizures,and focal neurological signs after the operation.Recording the incidence of transient aphasia,hemiplegia,dysarthria,and cerebral hemorrhage after the operation.Recording the changes in the reexamination of the brain CT after the operation,and the total days of hospitalization.The research made use of the statistical software-SPSS23.0 to analyze the data.In case the data is in line with the normal distribution,the mean±standard deviation(x±s)was used for data representation,if not,it is expressed by the median and interquartile range.One-way analysis of variance is noted by uni-variate test,and P<0.05 indicates that the difference is statistically significant.The factors included in the multivariate regression analysis include:the factors that are statistically significant in the uni-variate test,and the factors that are not statistically significant in the uni-variate analysis but are considered clinically significant.Use multivariate logistic regression on the selected factors in SPSS software to calculate the OR value and 95%confidence interval of each factor,and P<0.05 as the difference is statistically significant.Depending on whether overperfusion has occurred,the ROC curve was used to evaluate the reliability of MAP and rSO2 in predicting hyperperfusion,calculating the area under the curve and the 95%confidence interval.Results1、Comparison of common information of patients:1.1 The patient’s gender,age,BMI have nothing to do with postoperative cerebral(P>0.05).1.2 Whether the patient has diabetes,hypertension,and whether cerebral infarction occurred one month before the operation has nothing to do with the occurrence of cerebral hyper-perfusion(P>0.05).3、The risk factors for postoperative hyperperfusion include:MAP on the first day after surgery increased by 10-15%(P<0.001),OR(95%CI)was 30.667(5.236,179.621);on the first day after surgery The rSO2 on the affected side increased by more than 5%(P=0.037)than before the operation,and the OR(95%CI)was 24.293(1.215,485.730);on the fourth day after the operation,the MAP increased by more than 15%(P=0.004),OR(95%CI)was 6.840(1.871,25.005);on the fourth day after operation,the rSO2 on the affected side increased by more than 5%(P<0.001),OR(95%CI)was 26.000(4.928,137.178).4、According to whether hyperperfusion occurs,the ROC curve of MAP change and rSO2 change is drawn.The analysis results show that when the threshold of MAP change on the first day is 10.84%,the sensitivity is 0.714,the specificity is 0.604,and the area under the curve(95%confidence interval))Was 0.683(0.521-0.845);when the threshold of rSO2 change on the affected side was 6.5 on the first day,the sensitivity was 0.857,the specificity was 0.833,and the area under the curve(95%confidence interval)was 0.822(0.680-0.965);When the threshold for MAP change in four days is 16.33%,the sensitivity is 0.643,the specificity is 0.792,and the area under the curve(95%confidence interval)is 0.705(0.535-0.875);the threshold for the change in rSO2 on the fourth day is 6.5%At time,the sensitivity was 0.786,the specificity was 0.854,and the area under the curve(95%confidence interval)was 0.863(0.761-0.965).5、Patients with postoperative hyperperfusion have significantly longer hospital stays than those without hyperperfusion.(P<0.05).ConclusionsIn patients with moyamoya disease undergoing superficial temporal artery-middle cerebral artery bypass grafting under general anesthesia,postoperative changes in MAP and rSO2 values on the surgical side will affect the occurrence of hyperperfusion,which will lead to a series of complications such as headaches,seizures,focal neurological impairment,cerebral hemorrhage and so on.Therefore,postoperative blood pressure should be strictly controlled,rSO2 should be closely monitored to cut down the probability of occurrence of overperfusion in patients with moyamoya disease after bypass,shorten the length of hospital stay,and improve the prognosis of patients.