气管插管全身麻醉对小儿肾氧饱和度的影响  

A prospective assessment of renal oxygenation by near-infrared spectroscopy in children undergoing intratracheal general anesthesia

作　　者：邢大军[1] 姚翠翠[1] 谢越涛[1] 马星钢[1] 王常娥[1] Xing Dajun;Yao Cuicui;Xie Yuetao;Ma Xinggang;Wang Chang′e(Department of Anesthesiology,Shenzhen Children′s Hospital,Shenzhen 518038,China)

机构地区：[1]深圳市儿童医院麻醉科,518038

出　　处：《中华临床医师杂志（电子版）》2017年第24期2486-2488,共3页Chinese Journal of Clinicians(Electronic Edition)

基　　金：深圳市科技计划项目(JCYJ20160429175948904)

摘　　要：目的观察气管插管全身麻醉期间患儿的肾氧饱和度(RrSO_2)的变化,评估该全身麻醉对肾氧饱和度的影响。方法选择1岁以内肾功能正常行气管插管全身麻醉的患儿35例(其中新生儿10例),将近红外线分光仪(NIRS)探头分别固定于患儿左侧肾体表定位区(T10-L2)及左前额处,持续进行RrSO_2和脑氧饱和度(CrSO_2)监测。并记录麻醉前(即麻醉诱导前静息状态)、麻醉中(即气管插管术后至手术开始前)、麻醉后(手术结束拔除气管导管后)生命体征稳定时3个时点的CrSO_2、RrSO_2数据。同时记录脉搏氧饱和度(SpO_2)、心率(HR)、血压(BP)等血流动力学参数。采用单因素重复测量方差分析比较麻醉前、麻醉中、麻醉后3个时点的HR、BP、SpO_2、CrSO_2、RrSO_2水平的差异。结果患儿在麻醉中的SBP和DBP与麻醉前相比有所下降[(77.91±13.62)mmHg vs(81.63±13.43)mmHg,(40.71±9.02)mmHg vs(44.34±9.07)mmHg],差异有统计学意义(t=-3.714、-3.629,P <0.05),但无临床意义;麻醉后又恢复至麻醉前水平[(83.97±14.01)mm Hg和(46.17±10.54)mmHg)]。气管插管全麻过程中RrSO_2与CrSO_2呈正相关(r=0.550,P <0.01),而与SpO_2、HR、DBP、SBP无明显相关性(r分别为0.132、0.146、-0.137、-0.050,P均> 0.05)。结论常规气管插管全身麻醉对患儿RrSO_2无明显影响。ObjectiveTo determine whether a decrease in renal oxygenation occurs during intratracheal general anesthesia in children with normal renal function. MethodsNear infrared spectroscopy （NIRS） probes were applied to both the lateral flank （T10-L2） and lateral cerebral area of all patients with normal renal function undergoing general anesthesia. Information was recorded at 5-s intervals before, during, and after intratracheal general anesthesia. Simultaneously, additional hemodynamic parameters （pulse saturation, blood pressure, and heart rate） were recorded every 5 min. ResultsThirty-five children under 1 year of age were enrolled in the study. The children′s SBP and DBP during anesthesia significantly decreased compared to pre-anesthesia levels [（77.91±13.62） mmHg vs （81.63±13.43） mmHg, （40.71±9.02） mmHg vs （44.34±9.07） mmHg; t=-3.714, -3.629; P 〈 0.05], but there was no clinical significance. These values returned to pre-anesthesia levels after surgery [（83.97±14.01） mmHg vs （46.17±10.54） mmHg, P〉0.05]. A significant correlation was identified between cerebral regional oxygen saturation （CrSO2） and renal regional oxygen saturation （RrSO ） during general anesthesia （r=0.55, P 〈 0.01）. RrSO had no significant correlation with SpO2, HR, DBP, or SBP （r=0.132, 0.146, -0.137, -0.050; P 〉 0.05）. ConclusionRenal hypoxia does not occur during anesthesia in children with normal renal function.

关 键 词：肾氧饱和度 近红外线分光仪 全身麻醉 儿童 

分 类 号：R726.1[医药卫生—儿科]