七氟烷对小儿心肺转流中脑氧代谢的初步研究  

Study of sevoflurane on cerebral oxygen balance in children underwent cardiopulmonary bypass

作　　者：于新迪[1] 王伟[1] 张蔚[1] 沈佳[1] 唐嘉忠[1] 朱德明[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脏中心体外循环科,研究生200127

出　　处：《中国体外循环杂志》2012年第2期81-83,86,共4页Chinese Journal of Extracorporeal Circulation

基　　金：上海市科委重点项目资助(074119516);上海交通大学医学院科技基金项目(YZ1013)

摘　　要：目的了解七氟烷在先天性心脏病心肺转流(CPB)中对患者脑氧代谢的影响。方法选取46例接受先天性心脏病纠治手术的患儿,随机分为七氟烷组和对照组,两组内再分为紫绀型和非紫绀型。通过氧合器在CPB全程给予1%七氟烷,同时用无创性的近红外光谱仪(NIRS)技术观察并记录七氟烷组和对照组患儿麻醉前(T0)、主动脉阻断心脏停跳后(T1)、主动脉阻断15 min(T2)、主动脉开放时(T3)、心脏复跳后(T4)的NIRS监测指标脑组织氧合指数(TOI)、平均动脉血压(MAP)和混合静脉血氧饱和度(SvO2)。观察术后患者意识恢复状况,七氟烷对以上各项指标的影响以及两组内紫绀型和非紫绀型脑氧的变化;同时分析TOI与MAP、SvO2的相关性。结果与对照组相比,CPB期间七氟烷组患儿的MAP有所降低,TOI和SvO2相对较高。相关分析显示,TOI与MAP无显著线性相关,但与SvO2呈显著正相关(r=0.573,P<0.01)。结论CPB中给予七氟烷可以负向调节患儿的MAP,正向调节TOI和SvO2。Objective To investigate the application of sevoflurane in monitoring of cerebral oxygen balance during cardiopulmonary bypass with congenial heart disease.Methods Forty-six children underwent cardiac surgery were included in this study.Patients were randomly divided into experimental and control groups.In each group,the patients were divided into two parts with and without cyanosis.Tissue oxygenation index（TOI）,mean arterial pressure（MAP） and mixed venous oxygen saturation（SvO2） were recorded before anesthesia（T0）,after aortic clamping and cardiac arrest（T1）,15 min after aortic clamping（T2）,aortic declamping（T3） and cardiac rebeating（T4）.Postoperative consciousness state and the effect of sevoflurane on each index were observed.At the same time,the relationship between TOI,MAP and SvO2 were analyzed.Results Sevoflurane not only could reduce MAP,but also increase TOI,SvO2 of all patients to a certain extent.Correlation analysis revealed that TOI had no linear correlation with MAP,and TOI was significantly positively related to SvO2（r=0.573,P〈0.01）.Conclusion It concluded that 1% sevoflurane given by oxygenator could negatively affect MAP and positively affect TOI,SvO2 of children underwent cardiopulmonary bypass.

关 键 词：七氟烷 近红外光谱仪 脑组织氧合指数 平均动脉压 混合静脉血氧饱和度 

分 类 号：R726.1[医药卫生—儿科]