不同年龄室间隔缺损修补术患儿麻醉诱导期间不同潮气末二氧化碳分压对局部脑氧饱和度和血流动力学的影响  

Effect of end-tidal carbon dioxide partial pressure on cerebral oxygen saturation and hemodynamics during anesthesia induction in children undergoing ventricular septal defect repair

作　　者：汪晓南[1] 韩丁[1] 杨彦伟[1] 李刚[1] 欧阳川[1] Wang Xiaonan;Han Ding;Yang Yanwei;Li Gang;Ouyang Chuan(Anesthesia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院麻醉中心

出　　处：《中国医药》2018年第4期495-498,共4页China Medicine

基　　金：国家自然科学基金(81600383)~~

摘　　要：目的探讨不同年龄室间隔缺损(VSD)修补术患儿麻醉诱导期间不同潮气末二氧化碳分压(P_(ET)CO_2)对局部脑氧饱和度(rScO_2)和血流动力学的影响。方法选取2017年4-5月于首都医科大学附属北京安贞医院行择期VSD修补术患儿44例,按年龄分为≥6个月组(24例)和<6个月组(20例)。入室全身麻醉气管插管后,建立桡动脉血压监测并使用MostCare血流动力学监测仪,使用Fore-Sight连续监测右侧额部rScO_2。调整机械通气参数,分别使P_(ET)CO_2依次维持在30(P_1)、35(P_2)、40(P_3)、45(P_4)mmHg(1 mmHg=0.133 kPa)状态。记录P_1、P_2、P_3、P_4状态时rScO_2、心率、收缩压、重脉压与舒张压的差值、每搏指数、心排血指数、体循环阻力指数、脉压变异度。结果随P_(ET)CO_2升高,2组rScO_2均明显升高[<6个月组P_1、P_2、P_3、P_4状态时rScO_2分别为(65±3)%、(69±3)%、(74±3)%、(77±4)%;≥6个月组P_1、P_2、P_3、P_4状态时rScO_2分别为(71±6)%、(74±6)%、(78±5)%、(80±4.)%](均P<0.001);随P_(ET)CO_2变化,<6个月组rScO_2变化幅度大于≥6个月组(P=0.011)。随P_(ET)CO_2升高,≥6个月组收缩压、心排血指数、脉压变异度下降,<6个月组体循环阻力指数下降,≥6个月组和<6个月组心率均先下降后上升(均P<0.05)。≥6个月组收缩压高于<6个月组(P=0.024),其余参数组间比较差异均无统计学意义(均P>0.05)。结论 VSD患儿在麻醉诱导阶段,随着P_(ET)CO_2变化脑氧合和血流动力学变化反应良好,年龄较小患儿因脑血管功能储备有限,脑氧合受P_(ET)CO_2波动的影响更大。Objective To investigate the effect of end-tidal carbon dioxide partial pressure （PET CO2 ） on cerebral oxygen saturation（ rSeO2 ） and hemodynamics during anesthesia induction in children undergoing ventricular septal defect（VSD） repair. Methods A total of 44 children undergoing VSD repair from April to May 2017 in Beijing Anzhen Hospital, Capital Medical University were divided into t〉6 months group（ n = 24） and 〈 6 months group（ n = 20）. Radial artery pressure was monitored by the MostCare hemodynamic device and right frontal rScO2 was monitored by the Fore-Sight device during general anesthesia. PFT CO2 was. maintained at 30 （ P1 ）, 35 （ P2 ）, 40 （ P3 ） , 45 （ P4 ） mmHg; rSeO2, heart rate（HR） , systolic pressure, dicrotic pressure, diastolic pressure, stroke volume index, cardiac index（CI） , systemic vascular resistance jndex（SVRI） and pulse pressure variation（ PPV ） were recorded at P1, P2, P3, P4. Results rScO2 significantly increased with PETC02 in both groups[ rScO2 of ≥ 6 months group at P1, P2, 133, P4 was （65 ± 3） % , （69 ± 3 ） % , （74 ± 3 ） % , （77 ± 4） % ; rScO2 of 〈 6 months group at P1, P2, 193, P4 was （71 ± 6）% , （74 ± 6）% , （78 ± 5）% , （80 ± 4）% ] （P 〈 0. 001 ）. Variation amplitude of rScO2 in 〈 6 months group was more significant than that in ≥6 months group（ P =O. 011 ）. Systolic pressure, CI and PPV decreased with the increase of PET C02 in ≥ 6 months group; SVRI decreased with the increase of PETCO2 in 〈 6 months group ; HR decreased first then increased in both groups（ all P 〈 0.05 ）. Systolic pressure in /〉6 months group was significantly higher than that in 〈 6 months group（ P = 0. 024） ; there was no statistical differences of other parameters between groups （ P 〉 0.05 ）. Conclusions Variations of rScO2 and hemodynamics during anesthesia induction are tolerable in children undergoing VSD repair. Due to limited cerebral vascular function reserve, the cere

关 键 词：中国医药 室间隔缺损 发病年龄 二氧化碳 脑氧饱和度 血流动力学 

分 类 号：R541[医药卫生—心血管疾病]