Predictive Value Of Cerebral Oxygen Saturation On Postoperative Brain Injury In Infants With Cyanotic Congenital Heart Disease

Objective:The aim of the study was to analyze the the predictive effect of cerebral oxygen saturation on postoperative brain injury during perioperative cardiac surgery in infants with cyanotic congenital heart disease.To explore whether CrSO₂can accurately predict the occurrence of postoperative brain injury in this type of children during cardiopulmonary bypass（CPB）,and provide a theoretical basis for timely adjustment of perfusion parameters during surgery and improve the prognosis of children.Methods:Thirty-six infants with cyanotic congenital heart disease were randomly selected.All cases were operated under general anesthesia CPB,and the operation was successfully completed.Observe and record the following indicators of children:（1）clinical characters of children:diagnosis,gender,age of the month,weight,CPB time,operation time,the lowest temperature during the operation,pulse oxygen saturation（Sp O₂）before entering the room,tracheal intubation time and extubation time.（2）Before induction of anesthesia,it is T₀,tracheal intubation 5 min is T₁,ascending aorta block is 5 min is T₂,ascending aorta is opened 5 min is T₃,CPB end time is T₄,ultrafiltration end time is T₅,CPB end 3 h,8 h,and 24 h were recorded as T₆,T₇,and T₈,respectively,marked with CrSO₂and mean arterial pressure（MAP）values.（3）Record nasopharyngeal temperature at T₁,T₂,T₃,T₄,T₅,T₆,T₇,T₈,and simultaneously extract arterial blood and central venous blood to record arterial oxygen saturation（Sa O₂）,Arterial blood lactic acid（Lac）,arterial hemoglobin concentration（Hb）,central venous oxygen saturation（Scv O₂）according to blood gas analysis.（4）Collect arterial blood 0.5ml at T₁,T₅,T₆,T₇,T₈and 48h,72h after CPB for ELisa detection and record neuron-specific enolase（NSE）,S100 calcium binding protein B（S100 calcium-binding protein B,S100B）.According to the intraoperative brain function monitoring method recommended by Chinese experts’consensus on perioperative brain protection in cardiac surgery,the increase of S100Βand NSE in perioperative period can be diagnosed as brain injury.According to the occurrence of brain injury,the children were divided into two groups:brain non-injury group（CN group）and brain injury group（CD group）.Two independent sample t tests were used to analyze clinical data,MAP,CrSO₂,nasopharyngeal temperature,Hb,Sa O₂,Lac,Scv O₂values at T₁to T₈time points between brain injury（CD group）and normal brain group（CN group）.After binary Logistic regression analysis of significant variables,the risk factors for brain injury were obtained;the predictive value of CrSO₂at different time points for brain injury was determined using receiver operating characteristic（ROC）curves to analyze.Results:（1）Clinical characters:A total of 36 children were enrolled in this study,including 22male children and 14 female children,with a monthly age of（3.5±2.7）months,a weight of（4.7±1.1）kg,CPB time（116.89±35.19）min,and operation time（220.28±59.27）.Among them,8 cases of complete transposition of the great arteries,8 cases of complete endocardial cushion defect,10 cases of supracardia type pulmonary venous ectopic drainage,and 10 cases of tetralogy of Fallot.Among them,18（50%）cyanotic infants suffered from brain injury,and another 18（50%）cyanotic infants did not suffer from brain injury.There were no significant differences in age,sex,weight,Sp O₂entering room,cyanotic heart disease type,intraoperative minimum body temperature,CPB time,operation time and extubation time,Sa O₂,Hb,MAP,nasopharynx temperature,Lac and Scv O₂between the two groups（all P>0.05）.（2）The levels of CrSO₂in T₃,T₄,and T₅in the CD group were significantly reduced,and the difference was statistically significant compared with the CN group（all P<0.01）.There was no statistically significant difference in CrSO₂between the two groups at other time points（all P>0.05）.（3）According to the analysis of binary Logistic regression,T₃CrSO₂（P<0.01,OR=0.399,95%CI 0.215～0.740）,T₄CrSO₂（P<0.01,OR=0.276,95%CI 0.132～0.578）and T₅CrSO₂（P<0.01,OR=0.333,95%CI 0.162～0.681）,T₃,T₄and T₅CrSO₂were the risk factors of brain injury in cyanotic infants after CPB.（4）ROC curve analysis showed that the AUC values of T₃～T₅were 0.830,0.935 and0.904 respectively.Sensitivity was 77.8%,83.3%and 83.3%.The specificity was 83.3%,100%and 94.4%.The critical values of CrSO₂are 50.6%,49.3%and 49.9%.T₃,T₄and T₅CrSO₂had high diagnostic value for brain injury.Conclusion:CrSO₂ can accurately reflect cerebral oxygen supply and demand in infants with cyanotic congenital heart disease during cardiac surgery.CrSO₂is related to the increase of NSE and S100Βlevels in cyanotic infants after cardiac surgery,which can predict early postoperative brain injury.