腹部局部氧饱和度在先天性心脏病矫治术中的应用  

Application of Percutaneous Abdominal Oxygen Saturation in Corrective Surgery for Congenital Heart Disease

作　　者：李雪 邱林 郎志斌 徐红党 李亚楠 张浩然 林洪启 LI Xue;QIU Lin;LANG Zhibin;XU Hongdang;LI Yanan;ZHANG Haoran;LIN Hongqi(Department of Anesthesiology,Fuwai Central China Cardiovascular Hospital,Henan Provincial People’s Hospital,Zhengzhou 451464,China)

机构地区：[1]阜外华中心血管病医院河南省人民医院麻醉科,河南郑州451464

出　　处：《河南医学研究》2025年第8期1361-1365,共5页Henan Medical Research

基　　金：河南省医学科技攻关计划省部共建青年项目(SBJG202303028);河南省医学科技攻关计划联合共建项目(LHGJ20220124)。

摘　　要：目的 探讨婴幼儿先天性心脏病矫治术中腹部局部氧饱和度(ArSO _(2))的变化趋势及其临床价值。方法 随机选取阜外华中心血管病医院2023年9—12月体外循环(CPB)下接受室间隔缺损修补的患儿53例,体重4.0~9.8 kg,年龄2.5~11个月,美国麻醉医师协会分级Ⅱ~Ⅲ级。将近红外光谱仪(NIRS)的探头固定于患儿的肚脐正下方,术中持续监测ArSO _(2)。分别记录ArSO _(2)、鼻咽温、MAP等参数在入室后(T _(1))、CPB开始即刻(T _(2))、阻断升主动脉后5 min(T _(3))、开放升主动脉后5 min(T _(4))、CPB结束后5 min(T _(5))、出手术前5 min(T _(6))的变化。记录术中主动脉阻断时间、CPB时间、手术时间、监护室停留时间、机械通气时间、住院时间等相关情况。根据术后首次开始进食时间并分为胃肠功能滞后组、未发生胃肠功能滞后组。结果 53例婴幼儿中22例(41.5%)患儿发生胃肠功能滞后。T _(1)时,两组患儿ArSO _(2)差异无统计学意义(P>0.05)。T _(2~6)时,与未发生胃肠功能滞后组相比,胃肠功能滞后组患儿ArSO _(2)值低(P<0.05)。T _(1~6)时,两组患儿的鼻咽温及平均动脉压(MAP)差异无统计学意义(P>0.05)。与未发生胃肠功能滞后组相比,胃肠功能滞后组患儿的年龄偏小、体重低(P<0.05)。与未发生胃肠功能滞后组患儿比较,胃肠功能滞后组患儿主动脉阻断时间、CPB时间、手术时间增加,术后监护室停留时间、机械通气时间、住院时间长(P<0.05)。Pearson相关分析显示,ArSO _(2)与鼻咽温呈负相关(r=-0.321,P=0.019),与MAP呈正相关(r=0.421,P<0.001)。结论 近红外光谱成像作为一种新型肠道功能的无创监测手段,在婴幼儿先天性心脏病围手术期具有一定的临床指导价值。Objective To investigate the trend and clinical application value of abdominal oxygen saturation(ArSO _(2))in infants and young children undergoing corrective surgery for congenital heart disease.Methods A total of 53 children weighing 4.0-9.8 kg and aged 2.5-11 months,American Society of Anesthesiologists(ASA)classificationⅡ-Ⅲwho underwent ventricular septal defect repair under cardiopulmonary bypass(CPB)at the Fuwai Central China Cardiovascular Hospital from September to December 2023 were randomly selected.The probe of the near-infrared spectroscopy(NIRS)was fixed directly below the navel of the child,and the ArSO _(2) was continuously monitored during the operation.The changes in parameters such as ArSO _(2),nasopharyngeal temperature,and MAP after entry(T _(1)),immediately after CPB(T _(2)),5 minutes after aortic occlusion(T _(3)),5 minutes after aortic opening(T _(4)),5 minutes after CPB(T _(5)),and 5 minutes before surgery(T _(6))were record.Relevant information such as intraoperative aortic occlusion time,CPB time,and surgical time,ICU stay time,mechanical ventilation time,and hospitalization time were record.According to the time of first postoperative feeding,the children were divided into gastrointestinal dysfunction group and without gastrointestinal dysfunction group.Results Out of 53 infants and young children,22 cases(41.5%)experienced delayed gastrointestinal function.At T _(1),there was no statistically difference in ArSO _(2) between the two groups of children(P>0.05).At T _(2-6),compared with the group without gastrointestinal functional delay,the ArSO _(2) value of children with gastrointestinal functional delay was lower(P<0.05).There was no statistically difference in nasopharyngeal temperature and mean arterial pressure(MAP)between the two groups of children from T _(1-6)(P>0.05).Compared with the group without gastrointestinal functional delay,the age and weight of children in the gastrointestinal functional delay group were younger and lower(P<0.05).Compared with the group without gas

关 键 词：先天性心脏病 婴幼儿 氧饱和度 腹部 

分 类 号：R541.1[医药卫生—心血管疾病]