不同水平动脉血二氧化碳分压对室间隔缺损修补术婴儿心脑保护作用的研究  

The cardiocerebral protection of different levels of partial pressure of arterial carbon dioxide for the infants undergoing ventricular septal defect repair

作　　者：范凡 郭颖[1] 欧阳川[2] 刘迎龙[2] 谢思远[3] 柏松[1] 童峰[1] 郑佳[1] 郭张科 李奇林[1] 李晓峰[1] Fan Fan;Guo Ying;Ouyang Chuan;Liu Yinglong;Xie Siyuan;Bai Song;Tong Feng;Zheng Jia;Guo Zhangke;Li Qilin;Li Xiaofeng(Department of Cardiac Surgery,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China;Pediatric Cardiac Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Anesthesia,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京儿童医院国家儿童医学中心心脏外科,北京100045 [2]首都医科大学附属北京安贞医院小儿心脏中心,北京100029 [3]首都儿科研究所麻醉科,北京100020

出　　处：《中国医药》2023年第2期196-201,共6页China Medicine

摘　　要：目的探究不同水平动脉血二氧化碳分压(PaCO_(2))对室间隔缺损修补术婴儿的心脑保护作用。方法回顾性分析首都医科大学附属北京安贞医院2017年5月至2018年5月83例行室间隔缺损修补术婴儿的资料。采用呼气末二氧化碳分压(PETCO_(2))作为间接的、持续性指标来反映PaCO_(2),记录术前(T_(1))、切心包(T_(2))、停体外循环(T_(3))、停超滤(T_(4))及术毕(T_(5))时点的PETCO_(2),除T_(3)时点PaCO_(2)不受呼吸条件影响外,在其余时点PETCO_(2)为30~<40 mmHg(1 mmHg=0.133 kPa)的婴儿为低二氧化碳组(LP组,34例),PETCO_(2)为40~<50 mmHg的婴儿为高二氧化碳组(HP组,49例)。记录实验室指标,T_(1)、T_(4)时点动脉血气分析结果,T_(1)~T_(5)时点呼吸参数、局部脑氧饱和度(rScO_(2))、脑血流参数及血流动力学参数。结果术后1 d,2组肌酸激酶同工酶水平均高于术前3 d,但HP组低于LP组(P<0.05)。HP组T_(1)、T_(4)时点PaCO_(2)水平均高于LP组[(38±5)mmHg比(31±4)mmHg、(44±6)mmHg比(36±4)mmHg](均P<0.001)。HP组T_(1)~T_(5)时点分钟通气量、呼吸频率均低于LP组,PETCO_(2)水平均高于LP组(均P<0.05)。除T_(3)时点外,HP组各时点rScO_(2)、大脑中动脉平均流速均高于LP组,差异均有统计学意义(均P<0.05)。Pearson相关性分析结果显示,行室间隔缺损修补术婴儿PETCO_(2)与PaCO_(2)呈正相关(P<0.001)。结论通过精准管理将PaCO_(2)维持在正常偏高水平,可以安全有效地减轻室间隔缺损手术婴儿的心脑损伤。Objective To investigate the cardiocerebral protection of different levels of partial pressure of arterial carbon dioxide(PaCO_(2))for the infants undergoing ventricular septal defect(VSD)repair.Methods From May 2017 to May 2018,data of 83 infants undergoing VSD repair in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed.Partial pressure of end expiratory carbon dioxide(PETCO_(2))was used as an indirect and continuous index to reflect PaCO_(2).PETCO_(2)was recorded at before operation(T_(1)),pericardiotomy(T_(2)),stopping cardiopulmonary bypass(T_(3)),stopping ultrafiltration(T_(4))and the end of operation(T_(5)).Except that PaCO_(2)at T_(3)was not affected by respiratory conditions,infants with PETCO_(2)at 30-<40 mmHg at other time points were divided into low carbon dioxide group(LP group,34 cases),and infants with PETCO_(2)at 40-<50 mmHg were divided into high carbon dioxide group(HP group,49 cases).The laboratory indicators,arterial blood gas analysis at T_(1)and T_(4),respiratory parameters,regional cerebral oxygen saturation(rScO_(2)),cerebral blood flow parameters and hemodynamic parameters at T_(1)-T_(5)were recorded.Results One day after operation,the levels of creatine kinase isoenzyme in both groups were higher than those 3 d before treatment,while the level in HP group was lower than that in LP group(P<0.05).Levels of PaCO_(2)at T_(1)and T_(4)in HP group were higher than those in LP group[(38±5)mmHg vs(31±4)mmHg,(44±6)mmHg vs(36±4)mmHg](both P<0.001).At T_(1)-T_(5),minute ventilation and respiratory rate in HP group were lower than those in LP group and levels of PETCO_(2)were higher than those in LP group(all P<0.05).The rScO_(2)and average velocity of middle cerebral artery in HP group were higher than those in LP group at T_(1)-T_(5)except T_(3)(all P<0.05).Pearson correlation analysis showed that PETCO_(2)was positively correlated with PaCO_(2)in infants undergoing VSD repair(P<0.001).Conclusion As a safe and effective way,precision management on higher PaCO_(2)i

关 键 词：先天性心脏病 器官损伤 二氧化碳 

分 类 号：R726.1[医药卫生—儿科]