肾氧饱和度和腹部局部氧饱和度在婴幼儿心脏手术中的应用  

The application of percutaneous renal oxygen saturation and abdominal local oxygen saturation in infants undergoing cardiac surgery

作　　者：李雪 邱林[1] 徐红党 郎志斌[1] 范太兵[2] 彭帮田[2] 林洪启[1] Li Xue;Qiu Lin;Xu Hongdang;Lang Zhibin;Fan Taibing;Peng Bangtian;Lin Hongqi(Henan Province People′s Hospital,Department of Anesthesiology of Central China Fuwai Hospital,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 450018,China;Heart Center of Henan Province People′s Hospital,Central China Hospital,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 450018,China)

机构地区：[1]河南省人民医院,华中車外医院麻醉科,郑州大学华中阜外医院,郑州450018 [2]河南省人民医院心脏中心,华中阜外医院儿童心脏中心,郑州大学华中阜外医院,郑州450018

出　　处：《中华实用儿科临床杂志》2021年第1期28-32,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：河南省医学科技攻关计划省部共建项目(SB201901098);河南省医学科技攻关计划项目(2018020460)。

摘　　要：目的探讨肾氧饱和度(RrSO2)和腹部局部氧饱和度(A-rSO2)在婴幼儿心脏手术中的变化规律和临床应用价值。方法随机连续选取2019年4-8月河南省人民医院儿童心脏中心体外循环(CPB)下行房间隔缺损和/或室间隔缺损修补的患儿30例,男15例,女15例,年龄2~13个月,体质量4.5~10.0 kg,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级。应用近红外线分光仪的探头分别固定于患儿右肾体表定位处和肚脐下方1 cm,术中持续监测患儿RrSO2和A-rSO2。分别记录麻醉诱导后(T0),体外循环开始即刻(T1),阻断升主动脉后5 min(T2),体温最低时(T3),开放升主动脉后5 min(T4),停机后5 min(T5)的RrSO2、A-rSO2、平均动脉压(MAP)、鼻咽温等参数的变化。记录术中CPB时间、升主动脉阻断时间、手术时间等相关情况。记录围术期(术后)急性肾损伤(AKI)、胃肠道功能障碍等并发症发生情况。记录术后首次开始进食时间等相关情况。结果本研究共纳入30例患儿,患儿RrSO2和A-rSO2基础值分别为(70.00±7.50)%、(70.70±11.29)%。与T0比较,患儿RrSO2和A-rSO2在T1时下降,在T2、T3、T4时逐渐升高,在T5时恢复至T0水平。患儿RrSO2和A-rSO2在T0、T1、T2、T3、T4差异无统计学意义。Pearson相关分析显示患儿A-rSO2与RrSO2呈正相关(r=0.806,P<0.01),RrSO2和A-rSO2均与MAP呈正相关(r=0.565、0.605,均P<0.05),与鼻咽温均呈负相关(r=-0.365、-0.331,均P<0.05)。其中,术后发生AKI患儿3例,AKI总体发生率10%(3/30例)。与T0比较,患儿RrSO2值在T1、T2、T3、T4时明显降低(P<0.05)。术后发生胃肠功能滞后患儿6例,胃肠功能滞后总体发生率20%(6/30例)。胃肠功能滞后患儿A-rSO2值在T0~T5明显低于未发生胃功能滞后患儿(P<0.05)。结论作为一种新型无创监测手段,近红外线光谱技术在婴幼儿简单先天性心脏病修补术围术期肾功能和肠道功能的监测方面具有一定的临床指导价值。Objective To investigate the changes and their clinical values of renal oxygen saturation(RrSO2)and abdominal local oxygen saturation(A-rSO2)in infants who underwent cardiac surgery.Methods Thirty children with atrial septal defect or ventricular septal defect underwent cardiopulmonary bypass(CPB)in Henan People′s Hospital from April to August 2019 were randomly selected.There were 15 males and 15 females,aged 2-13 months,weighted 4.5-10.0 kg and American Society of Anesthesiologists(ASA)gradeⅠ-Ⅲ.The probe of near-infrared spectroscopy(NIRS)was fixed at the body surface of the right kidney and 1 cm below the umbilicus.RrSO2 and A-rSO2 were continuously monitored during operation.The changes of parameters,including RrSO2,A-rSO2,mean arte-rial pressure(MAP),and nose temperature were recorded after anesthesia induction(T0),cardiopulmonary bypass(T1),5 minutes after aortic blockade(T2),the lowest temperature(T3),5 minutes after aortic opening(T4),and 5 minutes after stopping cardiopulmonary bypass(T5).CPB time,ascending aorta occlusion time and operation time were recorded as well.Meanwhile,perioperative complications such as acute renal injury(AKI)and gastrointestinal dysfunction were recorded.Relevant information,including the time of first eating after operation was recorded.Results Totally,30 children were enrolled in this study.The basic values of RrSO2 and A-rSO2 were(70.00±7.50)%and(70.70±11.29)%,respectively.Compared with T0,the RrSO2 and A-rSO2 of patients decreased at T1,gradually increased at T2,T3 and T4,and returned to T0 at T5.There was no significant difference in RrSO2 and A-rSO2 at each observation point.Pearson correlation analysis displayed that there was a positive correlation between A-rSO2 and RrSO2(r=0.806,P<0.01).RrSO2 and A-rSO2 were positively correlated with MAP(r=0.565,0.605,all P<0.05),and negatively correlated with the nasopharynx temperature(r=-0.365,-0.331;all P<0.05).Among them,3 children(10%)suffered from AKI after operation.Compared with T0,RrSO2 values at T1,T2,T3 and T4 de

关 键 词：肾氧饱和度 腹部局部氧饱和度 心脏手术 婴幼儿 

分 类 号：R726.5[医药卫生—儿科]