婴幼儿法洛四联症根治术中肾氧饱和度变化规律研究  

Renal oxygen saturation changes in infants with tetralogy of Fallot undergoing surgery correction

作　　者：张冬妮 欧阳川[1] 谢思远 马骏[1] ZHANG Dongni;OUYANG Chuan;XIE Siyuan;MA Jun(Department of Anesthesiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所麻醉中心,100029 [2]首都儿科研究所附属儿童医院麻醉科

出　　处：《心肺血管病杂志》2020年第9期1093-1097,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市医院管理局临床医学发展专项(ZYLX201810)。

摘　　要：目的:使用近红外光谱技术(NIRS),以室间隔缺损(VSD)患儿为对照,研究法洛四联症(TOF)根治术中肾氧饱和度(rSkO2)变化规律。方法:本研究共纳入3~18个月龄患儿共84例,其中TOF根治术患儿41例(TOF组),VSD修补术患儿43例(VSD组)。术中使用Mostcare监测仪经桡动脉持续监测血流动力学参数,使用FORE-SIGHT近红外光谱仪持续监测左侧rSkO2,在切皮前(T1)、开心包(T2)、全流量(T3)、全流量后15 min(T4)、拔除主动脉插管后(T5)和术毕离室前(T6)记录患儿rSkO2,在T1、T2、T5、T6时间点记录患儿脉搏SpO2、HR、收缩压(SysP)、舒张压(DiaP)、重脉压(DicP)、心指数(CI)、每搏量指数(SVI)等血流动力学参数。使用儿科校正的RIFLE(pRIFLE)诊断标准诊断术后急性肾损伤(AKI)。结果:TOF组rSkO2在T1、T2、T5、T6点显著低于VSD组(P<0.05)。TOF组T1、T2点SpO2显著低于VSD组(P<0.01)。TOF组T5、T6点CI、SVI、SysP、DicP显著低于VSD组(P<0.01)。TOF组rSkO2在T6点与T1无显著差异。T1、T2点rSkO2与SpO2呈显著正相关(P<0.01),T5、T6点rSkO2与CI、SVI、DicP呈显著正相关(P<0.05)。结论:与VSD患儿比较,心脏畸形矫治前、后TOF患儿肾组织氧合更低。积极改善血流动力学对维护TOF患儿肾组织氧合有重要意义。要重视TOF患儿围术期肾组织氧合低下可能导致更严重的AKI。Objective:To evaluate intraoperative renal oxygen saturation(rSkO2)in tetralogy of Fallot(TOF)infants undergoing surgery correction by using near infrared spectroscopy.Methods:84 VSD and TOF infants undergoing surgery correction were enrolled in this study including 41 TOF infants and 43 VSD infants.Intraoperative hemodynamic parameters were monitored by Mostcare.rSkO2 was continuously measured during surgery and recorded at following time points:before surgical incision(T1),after cut pericardium(T2),cardiopulmonary bypass(CPB)initiation(T3),15 min after CPB(T4),after removal of aortic cannula(T5),and end of operation(T6).Pulse oxygen saturation(SpO2),heart rate(HR),systolic pressure(SysP),dicrotic pressure(DicP),diastolic pressure(DiaP),cardiac index(CI)and stroke volume index(SVI)were recorded at T1,T2,T5 and T6.Pediatric-corrected RIFLE(pRIFLE)criteria was used to diagnose postoperative acute kidney injury(AKI).Results:rSkO2 was significantly lower in TOF group than VSD group at T1,T2,T5 and T6(P<0.05).CI,SVI,SysP,DicP,DiaP were significantly lower in TOF group than VSD group at T5 and T6(P<0.01).There was no significantly difference in rSkO2 at T6 and T1 in TOF group.In the total cohort,rSkO2 was positively correlated with SpO2 at T1 and T2(P<0.01).rSkO2 was positively correlated with CI,SVI and DicP at T5 and T6(P<0.05).Conclusions:Renal oxygen saturation is lower in TOF infants than VSD infants before and after CPB.Optimizing hemodynamic management is important for renal oxygen delivery in TOF infants.Lower renal oxygen saturation may cause more serious acute kidney injury after surgery.

关 键 词：法洛四联症 急性肾损伤 肾氧饱和度 

分 类 号：R54[医药卫生—心血管疾病]