新生儿及婴幼儿深低温停循环与选择性脑灌注效果  

Effects of Deep Hypothermic Circulatory Arrest and Selective Antegrade Cerebral Perfusion in Neonates and Infants

作　　者：彭文英[1] 庄建[1] 陈欣欣[1] 陈寄梅[1] 陈萍[1] 李刚[1] 

机构地区：[1]广东省心血管病研究所心脏外科,广东广州510100

出　　处：《中国体外循环杂志》2009年第2期65-68,共4页Chinese Journal of Extracorporeal Circulation

基　　金：国家十一五科技支撑计划(2006BAI01A08)

摘　　要：目的分析和评价新生儿及小婴儿主动脉手术中使用深低温停循环(DHCA)与选择性顺行脑灌注(SACP)时脑氧饱和度变化和脑保护效果。方法主动脉缩窄或主动脉弓中断合并心内畸形患儿24例,其中男20例,女4例,年龄6～197(78±58)d,体重2.3～5.6(4.0±0.8)kg,随机分为DHCA组(15例)和SACP组(9例),后者在降至目标温度后经无名动脉顺行插管行持续性SACP,灌注流量15～30ml/(kg.min)。术中应用近红外分光光谱仪(NIRS)经皮连续监测脑组织氧合指数(TOI)变化。结果两组患儿均于术后24h内清醒,未出现近期神经系统并发症,3例患儿院内死亡。DHCA组和SACP组TOI基线值分别为(62±6)%和(61±7)%,差异无统计学意义(P>0.05)。DHCA开始后TOI值持续下降,至结束时达最低点,为29%～55%(42±8)%,较基线值降低最大百分比为16.8%～48.2%(32.5±9.8)%;SACP组在脑灌注后5min、10min、结束时TOI与基线值比较差异无统计学意义(P>0.05),与DHCA组比较,此三个时间点TOI较基线值下降百分比差异有统计学意义(P(0.05)。结论DHCA可明显降低脑组织氧合,但在一定时限内,DHCA与SACP两种方式对新生儿及小婴儿术后神经系统功能均无明显影响。OBJECTIVE To analyze changes of cerebral oxygen saturation during using deep hypothermic circulatory arrest （DHCA） and selective antegrade cerebral perfusion（SACP） in neonates and infants aortic surgery, and evaluate the cerebral protective effects as well. METHODS 24 patients diagnosed coaretation of aorta（CoA） or interrupted aortic arch（IAA） with congenital heart defects, aged 6 to 197 days average （78 ± 58 ）days, weighed 2.3 to 5.6 kg average （4.0 ±0.8 ） kg, were randomly divided into DHCA group （ n = 15 ） and SACP group （ n = 9）. Continuous SACP was established via the innominate artery cannulation after reaching target temperature, the flow rate was kept 15 -30 ml/ （kg·min）. Near - infrared spectroscopy （NIRS） was used to continuously monitor the cerebral tissue oxygenation index （TOI） percntaneously. RESULTS All patients recovered from anaesthesia within 24 hours and none appeared temporary neurologic complications, 3 died in hospital. There was no significant difference of the baselines of TOI between these two groups （62% ±6% and 61% ± 7%, P 〉 0.05 ）. After DHCA beginning, TOI decreased continuously and reached a nadir ranged 29% to 55% average（42 ±8）% at the end of DHCA. Comparing to the baseline, the maximum decrease of TOI was from 16.8% to 48.2% average（32.5 ±9.8） %. The TOI of SACP group at 5 min, 10 min and the end of SACP was similar to the baseline （ P 〉 0.05 ）. At the three time points, but the TOI of DHCA group decreased significantly than that of SACP group （ P 〈 0.05 ）. CONCLUSION DHCA can cause to obviously decrease in cerebral tissue oxygenation, but in a certain time period,there are no differences between DHCA and SACP in postoperative neurological outcomes for neonates and infants.

关 键 词：深低温停循环 选择性顺行脑灌注 婴幼儿 近红外分光光谱仪 

分 类 号：R726.5[医药卫生—儿科]