紫绀型先心病婴幼儿心肺转流期间Pv-aCO2/Ca-vO2对低氧的预测作用  

The predictive effect of venous-arterial-carbon dioxide partial pressure difference and arteriovenous oxygen content difference on hypoxia during cardiopulmonary bypass in infants with cyanotic congenital heart disease

作　　者：魏碧玉 杨慧芳 马丽娟 刘永哲[2] 李红芳 高明龙[2] WEI Bi-yu;YANG Hui-fang;MA Li-juan;LIU Yong-zhe;LI Hong-fang;GAO Ming-long(Department of Anesthesiology,Shanxi Medical University,Taiyuan 030000,China;Department of Anesthesiology,the Seventh Medical Center,PLA General Hospital;Beijing Second Foreign Language College Hospital)

机构地区：[1]山西医科大学麻醉学系,030000 [2]解放军总医院第七医学中心麻醉科 [3]北京第二外国语大学校医院

出　　处：《天津医药》2019年第12期1239-1243,共5页Tianjin Medical Journal

基　　金：北京市科技委员会基金资助项目(Z1711000000417035)

摘　　要：目的探究在紫绀型先心病(CCHD)婴幼儿心肺转流(CPB)期间中心静脉-动脉二氧化碳分压差与动脉-中心静脉血氧含量差异比(Pv-aCO2/Ca-vO2)对低氧的预测价值。方法选取CPB下接受心脏手术的0~1岁CCHD患儿30例,分别于气管插管后(T1)、升主动脉夹闭后5 min(T2)、升主动脉开放后5 min(T3)、CPB结束(T4)、超滤结束(T5)进行动、静脉血气分析并记录动脉血二氧化碳分压[pa(CO2)]、中心静脉血二氧化碳分压[pv(CO2)]、动脉血氧分压[pa(O2)]、中心静脉血氧分压[pv(O2)]、动脉血氧饱和度(SaO2)、中心静脉血氧饱和度(SvO2)、动脉血红蛋白浓度(CaHb)、中心静脉血红蛋白浓度(CvHb)、动脉血乳酸(Lac)、平均动脉压(MAP)、鼻咽温度,根据公式计算Pv-aCO2/Ca-vO2,记录患儿术后连续7 d的血肌酐。比较各时间点Pv-aCO2/Ca-vO2、Lac、MAP、鼻咽温的变化情况,分析Pv-aCO2/Ca-vO2与Lac的相关性,以Lac>3 mmol/L为判断低氧金标准,受试者工作特征(ROC)曲线分析不同时间点Pv-aCO2/Ca-vO2对低氧的预测价值。根据改善全球肾脏病预后组织(KDIGO)对患儿进行急性肾损伤(AKI)诊断,比较各时间点高Pv-aCO2/Ca-vO2和高Lac婴幼儿中AKI的发生率。结果与T1相比,T2、T3、T4时点Pv-aCO2/Ca-vO2和Lac显著增高(P<0.01),T5时点Pv-aCO2/Ca-vO2与T1相比差异无统计学意义(P>0.05),T5Lac高于T1(P<0.05);与T4相比,T5Pv-aCO2/Ca-vO2、Lac均显著降低(P<0.05);与T1相比,T2MAP、鼻咽温显著降低(P<0.05)。T2、T3时点Pv-aCO2/Ca-vO2与Lac呈正相关(r分别为0.87和0.68,P<0.01)。T2时点Pv-aCO2/Ca-vO2预测低氧的曲线下面积(AUC)为0.926(95%CI:0.670~0.997,P<0.000 1),以Pv-aCO2/Ca-vO2=0.35为截点时,对低氧的诊断敏感度为100%,特异度为77.78%,T3时点Pv-aCO2/Ca-vO2预测低氧的AUC无统计学意义(P>0.05)。T2时点Pv-aCO2/Ca-vO2>0.35婴幼儿中术后AKI的发生率显著高于Lac>3 mmol/L组(P<0.05)。结论 CCHD婴幼儿CPB期间,主动脉夹闭后5 min Pv-aCO2/Ca-vO2高于0.35能判断低�Objective To explore the predictive value of venous-arterial-carbon dioxide partial pressure difference and arteriovenous oxygen content difference(Pv-aCO2/Ca-vO2) to hypoxia during cardiopulmonary bypass(CPB) in infants with cyanotic congenital heart disease(CCHD).Methods Thirty children(0-1 year-old) with CCHD underwent cardiac surgery were enrolled.Arterial blood carbon dioxide partial pressure [pa(CO2)],central venous blood carbon dioxide partial pressure [pv(CO2)],arterial oxygen partial pressure [pa(O2)],central venous oxygen partial pressure [pv(O2)],arterial oxygen saturation(SaO2),central venous oxygen saturation(SvO2),arterial hemoglobin concentration(CaHb),central venous hemoglobin concentration(CvHb),arterial blood lactate(Lac),mean arterial pressure(MAP) and nasopharyngeal temperature were recorded,and arterial blood gas and venous blood gas were also checked at five different points of time:after tracheal intubation(T1),5 min after ascending aortic clamping(T2),5 minutes after the ascending aorta was opened(T3),off CPB(T4),end of ultrafiltration(T5).Pv-aCO2/Ca-vO2 was calculated according to formula.Changes of Pv-aCO2/Ca-vO2,Lac,MAP and nasopharyngeal temperature were comparison at each time points.Data of blood creatinine for seven consecutive days after surgery were recorded.The correlation between Pv-aCO2/Ca-vO2 and Lac at each time point was analyzed.The receiver operating characteristic(ROC) curve was used to analyze the predicted value of Pv-aCO2/Ca-vO2 to hypoxia at different time points.According to the Kidney Disease:Improving Global Outcomes(KDIGO),infants with acute kidney injury(AKI) were diagnosed.The incidence of AKI was compared at each time point between infants with high Pv-aCO2/Ca-vO2 and infants with high Lac.Results Pv-aCO2/Ca-vO2 and Lac were significantly increased in T1 compared with that of T2,T3 and T4(P <0.01).There was no significant difference in Pv-aCO2/Ca-vO2 between T5 and T1(P> 0.05).Lac was significantly higher at T5 than that of T1(P <0.05).Pv-aCO2/Ca-vO2 and Lac we

关 键 词：婴儿 新生 疾病 心脏缺损 先天性 心肺转流术 诊断 鉴别 低氧 紫绀型先心病 Pv-aCO2/Ca-vO2 

分 类 号：R725.411[医药卫生—儿科]