双向腔肺分流术后不同通气程度对脑血流的影响  

The effects of ventilation level on cerebral blood flow alter bidirectional superior cavopulmonary anastomosis

作　　者：鲁亚南 刘锦纷[1] 史珍英[1] 徐志伟[1] 苏肇伉[1] 丁文祥[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科, 200127

出　　处：《中华胸心血管外科杂志》2009年第4期251-253,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的观察双向腔肺分流术后不同通气程度对脑血流及系统氧饱和度的影响。方法随机抽取8例功能性单心室行双向腔肺分流术病儿。术后3～5h血流动力学平稳后进行研究，初始呼吸机参数设定容量控制的SIMV模式。通过调整呼吸机频率获得不同通气状态。更换通气状态后20min记录数据，记录3种连续的通气状态下动脉血气分析、血流动力学指标、颈内动脉多普勒血流频谱，用近红外组织血氧监测仪持续监测脑组织血氧参数。结果高通气状态下，动脉血压和上腔静脉压明显下降，平均动脉氧分压和二氧化碳分压明显下降。反映脑血流量的指标颈内动脉血流峰值速度以及脑组织中含氧血红蛋白的含量也明显下降。而在低通气状态下，可以观察到相反的结果。结论不同通气状态可以明显影响双向腔肺分流术后血流动力学状况、动脉氧饱和度及脑血流量。与高通气相比，低通气状态降低脑血管床阻力，因此可以增加双向腔肺分流术后脑一肺串联的血流量，提高双向腔肺分流术后氧饱和度。Objective To determine the effects of different ventilation level on cerebral blood flow after bidirectional superior cavopulmonary anastomosis. Methods Eight pediatric patients who underwent bidirectional superior cavopulmonary anastomosis were enrolled in this study. Patients were studied within 3-5 hours after the operation while stable hemodynamic status achieved. Initial ventilation parameters were set as synchronized intermittent mandatory ventilation, volume control mode. Different ventilation level was achieved by adjusting mechanical ventilation frequency. Blood gas analysis, hemodynamic parameters and Doppler determinations of internal carotid artery were obtained after at least a 20-minute stabilization period at each time point of the protocol. During the study the oxyhemoglobin in the cerebral tissue was continually monitored using near-infrared spectroscopy. Results During hyperventilation, there were significant decreases in arterial pressure and superior vena cava pressure. The mean arterial partial pressure of oxygen and carbon dioxide beth decreased significantly, while the peak velocity of the internal carotid artery blood flow end the oxyhemoglobin in the cerebral tissue which represent the perfusion of the cerebral tissue was also decreased significantly. During hypoventilation, the opposite phenomenon were observed. Conclusion Hemodynamic status, systemic oxygenation, cerebral blced flow and thus the pulmonary blood flow can be affected by ventilation level after bidirectional superior cavapulmenary anastomosis. Compared with hyperventilation, hypoventilation improves systemic oxygenation and arterial blood pressure. The mechanism of these effects is supposed that hypoventilation decreases cerebral vascular resistance, thus increasing blood flow through cerebral-pulmonary series after superior bidirectional cavapulmonary anastomosis.

关 键 词：心脏缺损 先天性 心转流术 右 呼吸 人工 

分 类 号：R686[医药卫生—骨科学]