以rScO_(2)和Pcv-aCO_(2)为主要目标的循环管理策略对紫绀型先心病患儿近期预后的影响  

Effect of cyclic management strategy with rScO_(2)and Pcv-aCO_(2)as the main goal on the short term prognosis of children with cyanotic congenital heart disease

作　　者：王影 刘永哲[2] 陈艺舟 吴伟[3] 洪小杨 高明龙[1,4] Wang Ying;Liu Yong-Zhe;Chen Yi-Zhou;Wu Wei;Hong Xiao-Yang;Gao Ming-Long(School of Anesthesiology,Shanxi Medical University,Taiyuan,Shanxi 030000,China;Department of Anesthesiology,the Third Medical Center of Chinese PLA General Hospital,Beijing 100039,China;Pediatric Intensive Care Unit,the Seventh Medical Center of Chinese PLA General Hospital,Beijing 100700,China;Department of Anesthesiology,the Seventh Medical Center of Chinese PLA General Hospital,Beijing 100700,China)

机构地区：[1]山西医科大学麻醉学院,山西太原030000 [2]解放军总医院第三医学中心麻醉科,北京100039 [3]解放军总医院第七医学中心儿童重症监护病房,北京100700 [4]解放军总医院第七医学中心麻醉科,北京100700

出　　处：《解放军医学杂志》2022年第7期709-716,共8页Medical Journal of Chinese People's Liberation Army

基　　金：首都卫生发展科研专项(2020-2-5092)。

摘　　要：目的探讨以局部脑氧饱和度(rScO_(2))和中心静脉-动脉二氧化碳分压差(Pcv-aCO_(2))为主要目标的循环管理策略对紫绀型先心病(CCHD)患儿近期预后的影响。方法纳入2020年10月-2021年6月在解放军总医院第七医学中心于体外循环(CPB)下接受心脏手术的72例0~1岁CCHD患儿,随机分为对照组(n=36)与干预组(n=36)。对照组实施传统循环管理策略,干预组实施以rScO_(2)和Pcv-aCO_(2)为主要目标的个体化循环管理策略。记录并比较两组患儿气管插管开放动静脉后(T_(1))、升主动脉夹闭后5 min(T_(2))、升主动脉开放后5 min(T_(3))、超滤结束(T_(4))、CPB结束后3 h(T_(5))、CPB结束后8 h(T_(6))、CPB结束后24 h(T_(7))的平均动脉压(MAP)、咽温(T)、血红蛋白(Hb)、动脉血氧饱和度(SaO_(2))、动脉血二氧化碳分压(PaCO_(2))、rScO_(2)、Pcv-aCO_(2)、动脉血乳酸(Lac)和中心静脉血氧饱和度(ScvO_(2)),CPB时间、手术时间、拔管时间、ICU停留时间、出院时间,以及急性肾损伤(AKI)、肺部感染、呼吸衰竭的发生情况等。结果两组患儿T_(1)-T_(7)时MAP、T、Hb、SaO_(2)差异无统计学意义(P>0.05)。与对照组比较,干预组患儿PaCO_(2)在T_(2)、T_(3)、T_(6)、T_(7)时明显增高,rScO_(2)在T_(3)-T_(6)时明显增高(P<0.05),Pcv-aCO_(2)在T_(1)-T_(7)时明显降低(P<0.05),Lac水平在T_(3)、T_(5)时明显降低(P<0.05),ScvO_(2)在T_(2)、T_(3)时明显降低(P<0.05)。两组CPB时间、手术时间、拔管时间及术后肺部感染、呼吸衰竭的发生率差异无统计学意义(P>0.05);干预组ICU停留时间、住院时间明显短于对照组[(5.67±1.50)d vs.(7.28±2.11)d,P<0.05;(14.67±3.41)d vs.(19.00±2.63)d,P<0.05],术后AKI发生率明显低于对照组[25.0%(9/36)vs.50.0%(18/36),P<0.05]。结论围手术期以rScO_(2)和Pcv-aCO_(2)为主要目标的个体化循环管理策略对CCHD患儿的近期预后具有明显改善作用。Objective To investigate the effect of circulatory management strategy with regional cerebral oxygen saturation(rScO_(2))and central venous-arterial differential pressure of carbon dioxide(Pcv-aCO_(2))as the main targets on the short term prognosis of children with cyanotic congenital heart disease(CCHD).Methods A total of 72 children with CCHD aged 0-1 year,who underwent cardiac surgery under cardiopulmonary bypass(CPB)in the Seventh Medical Center of Chinese PLA General Hospital from October 2020 to June 2021,were selected as research objects,and randomly divided into control group(n=36)and intervention group(n=36).The control group was implemented with traditional circulation management strategy,while the intervention group was implemented the individualized circulation management strategy with rScO_(2)and Pcv-aCO_(2)as the main targets.The mean arterial pressure(MAP)of endotracheal intubation opening the arteries and veins(T_(1)),5 minutes after clipping of ascending aorta(T_(2)),5 minutes after opening of ascending aorta(T_(3)),end of ultrafiltration(T_(4)),3 hours after end of CPB(T_(5)),8 hours after end of CPB(T_(6))and 24 hours after end of CPB(T_(7))of the two groups of children were recorded,respectively,as well as the pharyngeal temperature(T),hemoglobin(Hb),arterial oxygen saturation(SaO_(2)),partial pressure of carbon dioxide in artery(PaCO_(2)),rScO_(2),Pcv-aCO_(2),arterial blood lactate(Lac)and central venous oxygen saturation(ScvO_(2)),CPB time,operation time,extubation time,ICU stay time,discharge time,and acute kidney injury(AKI),lung infection,and respiratory failure.Results No significant difference existed in MAP,T,Hb and SaO_(2)between the two groups at T_(1)-T_(7)(P>0.05).Compared with control group,PaCO_(2)in the intervention group was significantly increased at T_(2),T_(3),T_(6)and T_(7),rScO_(2)was significantly increased at T_(3)-T_(6)(P<0.05),and Pcv-aCO_(2)was significantly decreased at T_(1)-T_(7)(P<0.05),Lac levels were significantly decreased at T_(3)and T_(5)(P<0.05),and ScvO_(2)

关 键 词：先天性心脏病 传统循环管理策略 个体化循环管理策略 体外循环 近期预后 

分 类 号：R614[医药卫生—麻醉学]