发绀型先天性心脏病患儿改良体-肺动脉分流术中局部脑氧饱和度的变化  

Changes of regional cerebral oxygen saturation in children with cyanotic congenital heart disease undergoing modified systemic-pulmonary artery shunt

作　　者：王菲[1] 谢思远 欧阳川[1] 马骏[1] Wang Fei;Xie Siyuan;Ouyang Chuan;Ma Jun(Anesthesiology Center,Beijing Anzheu Hospital,Capital Medical Unwersity,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China;Department of Anesthesiology,Children's Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京安贞医院麻醉中心,北京市心肺血管疾病研究所,100029 [2]首都儿科研究所附属儿童医院麻醉科,北京100020

出　　处：《中国医药》2021年第11期1631-1634,共4页China Medicine

基　　金：北京市医院管理局重点医学专业发展计划(ZYLX201810)。

摘　　要：目的探讨发绀型先天性心脏病患儿改良体-肺动脉分流术(MBTS)中局部脑氧饱和度(rScO_(2))的变化特征及相关因素。方法选择2019年1月至2020年12月于首都医科大学附属北京安贞医院择期行MBTS的发绀型先天性心脏病患儿42例。所有患儿术中均连续监测rScO_(2)及血流动力学相关参数,并分别于切皮前(T_(1))、打开心包(T_(2))、阻断术侧肺动脉5 min(T_(3))、人工血管通血3 min(T_(4))、术毕(T_(5))5个时点,记录rScO_(2)、脉搏血氧饱和度(SpO_(2))、呼气末二氧化碳分压(P_(ET)CO_(2))、收缩压、舒张压、心脏指数、脉压变异度等指标,并计算血管活性药物评分(VIS)。结果T_(3)时点rScO_(2)、SpO_(2)、P_(ET)CO_(2)均显著低于其他时点,T_(4)时点rScO_(2)显著高于T_(1)时点[(77±9)%比(75±9)%],T_(5)时点rScO_(2)[(74±8)%]显著低于T_(4)时点(均P<0.05)。T_(4)时点SpO_(2)显著高于T_(1)、T_(2)、T_(5)时点[(92±4)%比(86±6)%、(89±5)%、(88±5)%](均P<0.05)。T_(4)、T_(5)时点P_(ET)CO_(2)显著高于T_(1)、T_(2)时点,T_(3)时点收缩压低于T_(2)、T_(5)时点,T_(4)时点舒张压低于T_(1)、T_(2)、T_(5)时点,T_(4)时点心脏指数低于T_(1)、T_(2)时点,T_(5)时点脉压变异度低于其他各时点(均P<0.05)。VIS在T_(3)时点显著高于其他各时点(均P<0.05),在T_(4)、T_(5)时点开始降低,且两时点间差异有统计学意义,但T_(4)时点VIS仍高于T_(1)、T_(2)时点(均P<0.05)。rScO_(2)与SpO_(2)术中整体变化趋势有相关性(r=0.339,P=0.001);T_(4)时点rScO_(2)与P_(ET)CO_(2)、舒张压、VIS均有相关性(r=0.571、0.563、0.456,均P<0.05)。结论发绀型先天性心脏病患儿的发绀严重程度和MBTS术中阻断肺动脉是影响患儿rScO_(2)的重要因素;人工血管通血后,积极扩容并逐渐降低血管活性药物输注剂量,脑氧合明显改善;术毕不能盲目通过提高SpO_(2)增加rScO_(2)。Objective To investigate the changes and related factors of regional cerebral oxygen saturation(rScO_(2))in children with cyanotic congenital heart disease undergoing modified systemic-pulmonary artery shunt(MBTS).Methods From January 2019 to December 2020,42 children with cyanotic congenital heart disease undergoing elective surgery in Beijing Anzhen Hospital,Capital Medical University were enrolled.The rScO_(2) and hemodynamic parameters of children were continuously monitored.The rScO_(2),pulse oxygen saturation(SpO_(2)),partial pressure of end-tidal carbon dioxide(PETCO_(2)),systolic blood pressure(SBP),diastolic blood pressure(DBP),cardiac index(CI),pulse pressure variation(PPV)were recorded before incision(T_(1)),at opening the pericardium(T_(2)),5 min after blocking pulmonary artery(T_(3)),3 min after the artificial vascular opened(T_(4))and the end of surgery(T_(5)),and the vasoactive-inotropic score(VIS)were calculated.Results The rScO_(2),SpO_(2),PETCO_(2)at T_(3)time point were significantly lower than those at other time points,rScO_(2) at T_(4) time point was higher than that at T_(1)time point[(77±9)%vs(75±9)%],and rScO_(2)at T_(5)time point[(74±8)%]was lower than that at T_(4)time point(all P<0.05).SpO_(2) at T_(4) time point was higher than that at T_(1),T_(2)and T_(5)time points[(92±4)%vs(86±6)%,(89±5)%,(88±5)%](all P<0.05).PETCO_(2)at T_(4),T_(5)time points were higher than that at T_(1) and T_(2) time points,SBP at T_(3)time point was lower than that at T_(2)and T_(5)time points,DBP at T_(4)time point was lower than that at T_(1),T_(2)and T_(5)time points,CI at T_(4)time point was lower than that at T_(1)and T_(2)time points,and PPV at T_(5)time point was lower than that at other time points(all P<0.05).VIS at T_(3)time point was higher than that at other time points(all P<0.05),that decreased at T_(4)and T_(5)time points,and there was significant difference between the two time points,but that at T_(4)time point was still higher than that at T_(1)and T_(2)time points(all P<0.05).The rSc

关 键 词：发绀型先天性心脏病 局部脑氧饱和度 改良体-肺动脉分流术 

分 类 号：R54[医药卫生—心血管疾病]