先天性心脏病新生儿围手术期脑氧供需平衡与皮层脑功能研究  

Perioperative balance between cerebral oxygen supply and utilization and cerebral activity in newborns with congenital heart disease

作　　者：桂娟[1] 孙云霞[1] 刘玉梅[1] 钟劲[1] 余宇晖[1] 陈寄梅[2] Gui Juan;Sun Yunxia;Liu Yumei;Zhong Jin;Yu Yuhui;Chen Jimei(Department of NICU,Guangdong Academy of Medical Science,Guangdong Provincial People’s Hospital,Guangzhou 510080,China;Guangdong Academy of Medical Sciences,Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of South China Structural Heart Disease,Guangdong Provincial Peoples Hospital,Guangzhou 510080,China)

机构地区：[1]广东省医学科学院,广东省人民医院新生儿重症监护室,广州510080 [2]广东省医学科学院,广东省心血管病研究所,广东省华南结构性心脏病重点实验室,广东省人民医院心外科,广州510080

出　　处：《中华胸心血管外科杂志》2022年第1期38-43,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划(2018YFC1002600);广东省医学科学技术研究基金(A2020004)。

摘　　要：目的探索先天性心脏病(CHD)新生儿手术前后脑氧供需平衡与脑功能的影响因素。方法选取我院NICU收治的CHD新生儿,分别在手术前、后采用近红外线光谱技术(NIRS)监测脑组织血氧饱和度(TOI)和氧摄取分数(FTOE),结合临床特征和振幅整合脑电图(aEEG)的结果,分析手术前、后TOI、FTOE的水平和影响因素。结果共纳入90例CHD新生儿,术前监测TOI 0.56±0.05,术后0.59±0.03,均低于正常新生儿平均水平(P<0.05)。术前FTOE 0.36±0.07,术后FTOE 0.39±0.04。术后TOI、FTOE均较术前明显改善。TOI术后较术前改善程度与术前发绀程度呈负相关(β:-0.202),术后FTOE则无明显差异。术前需要呼吸支持的患婴,术前TOI水平较低(β:-0.879));术前导管前SpO2较高,则术前TOI也较高(β:0.214)。术前aEEG背景模式轻度异常的患婴术后FTOE较背景模式正常的患婴显著减低(P<0.05),术后aEEG监测显示睡眠觉醒周期(SWC)不成熟的患婴术后TOI较SWC成熟的患婴显著减低(P<0.05)。延迟关胸是术后死亡的风险因素。结论CHD患婴术后TOI较术前明显改善,尤其是紫绀型CHD改善显著。术前TOI与呼吸支持级别负相关,与导管前SpO2正相关。术前脑电活动波幅较低的患婴术后脑氧摄取分数亦较低。术后监测脑功能异常则脑氧饱和度亦较低。NIRS监测TOI与aEEG检测皮层脑功能,具有较好的一致性,可以用于指导CHD新生儿围手术期脑保护策略的目标管理。Objective To determine the risk factors of perioperative cerebral oxygen supply and utilization and cerebral activity in newborns with congenital heart disease(CHD).Methods In this prospective cohort study,NIRS and amplitude integrated EEG(aEEG)performed before and after surgery were used to assess cerebral oxygen supply and utilization and cerebral activity in these newborns.Cerebral tissue oxygenation index(TOI)and fractional tissue oxygen extraction(FTOE)measured from NIRS for each patient were compared to background pattern and SWC of aEEG before and after surgery.Analysis included clinical characteristics and explore the risk factors of TOI,FTOE.Results 90 CHD newborns were obtained.Pre-and postoperative TOI were 0.56±0.05 and 0.59±0.03,both of them were lower than the average for normal newborns(P<0.05).Pre-and postoperative FTOE were 0.36±0.07 and 0.39±0.04.TOI and FTOE were significantly improved after surgery(P<0.05).There was negative correlation between the TOI improvement after surgery and SpO2 of right upper limb(β:-0.202).Patient with Respiratory support before surgery had lower preoperative TOI levels(β:-0.879).Preoperative SpO2 was higher,then preoperative TOI was also higher(β:0.214).The postoperative FTOE of who had lower amplitude showed by aEEG was significantly lower(P<0.05).The postoperative TOI of who had immature SWC was lower than mature SWC(P<0.05).Delayed chest closure was a risk factor for postoperative death.Conclusion TOI in children with CHD improved significantly after operative,especially in patient with cyanosis CHD.Preoperative TOI is positively related to SpO2.It’s positive correlation between cerebral activity and cerebral oxygen utilization.The patient who has immature SWC showed lower cerebral oxygen supply.Monitoring cerebral activity and oxygenation may be useful in perioperative management and cerebral protection of newborns with CHD.

关 键 词：心脏手术 先天性心脏病 新生儿 脑氧饱和度 皮层功能 

分 类 号：R722.1[医药卫生—儿科]