婴幼儿室间隔缺损修补手术脑氧饱和度变化研究

摘要

Objective:During surgery repair of ventricular septal defect for infants and children,by monitoring cerebral tissue oxygen saturation (Sct O2) pre-CPB,during CPB,post-CPB and combining with other hemodynamic parameters,to study correlation between SctO2 and patients' weights,and analyze Sct O2 changes pre-and post-surgery repair,pre-and post-modified ultrafiltration.Methods:A total of 45 patients with ventricular septal defect were enrolled,the median (interquartile range) age,weight,height,and body surface area were 1.01 (0.2-5.1) years,8.15 (4.0-18.4) kg,76.2 (52.0-10) cm,0.39 (0.24-0.74) m2.Intravenous combined anesthesia,routine CPB technique,and modified ultrafiltration post-CPB were applied.Duration of surgery,CPB and aortic cross-clamping time were recorded.SctO2 was recorded before surgical incision (T1),opening pericardium (T2),5 min after CPB initiation (T3),5 min before separation from CPB (T4),separation from CPB (T5),post modified ultrafiltration (T6),end of surgery (T7),HR,SBP,DBP,stroke volume index (SVI),systemic vascular resistance index (SVRI),cardiac index (CI),pulse pressure variation (PPV),the maximal slope of systolic upstroke (dp/dtmax),cardiac cycle efficiency (CCE),SpO2were recorded at T1,T2,T5,T6,T7.Results:Sct O2was significantly and positively related with age,weight,height,body surface area at T1,T2,T3,T4,T5,T7 (P ＜ 0.01).SctO2 was significantly lower at T4 and T5 compared with other points (P ＜ 0.01),and SctO2 at T4 and T5 were not significantly different.Compared with T5,at T6 SBP,DBP,CI,SVI,CCE and dp/dtmax increased significantly (P ＜0.01 for all),PPV and SVRI decreased significantly (P ＜0.01).From T5 to T6,change in Sct O2was significantly related with that in CI and SVI,correlation coefficients were 0.361 and 0.380 respectively(P ＜0.05).Compared with T2,at T6 CI and SctO2were not significantly different (P ＞ 0.05).Conclusion:Sct O2was closely related with age and body surface area.During CPB,especially separation from CPB,cerebral oxygen delivery was impaired,after modified ultrafiltration,SctO2improved and restored to pre-CPB level.%目的:婴幼儿室间隔缺损修补手术中,通过监测体外循环前、中、后脑氧饱和度(SctO2)并结合其他血流动力学生理参数,研究患儿体质量与SctO2的相关性,以及手术矫治前后、改良超滤前后SctO2的变化.方法:选择先天性心脏病室间隔缺损患儿45例,中位年龄1.01 (0.2,5.1)岁、中位体质量8.15(4.0,18.4)kg,中位身高76.2(52.0,109) cm、中位体表面积(BSA)0.39(0.24,0.74) m2,采用静脉复合麻醉方式.常规体外循环技术,停机后采用改良超滤.记录手术时间、体外循环时间、升主动脉阻断时间.分别在切皮前(T1)、开心包(T2)、体外循环开始5min(T3)、停机前5min(T4)、停机时(T5)、改良超滤结束(T6)、术毕(T7)记录各时点SctO2,在T1、T2、T5、T6、T7点记录HR、SBP、DBP、每搏指数(SVI)、体循环阻力指数(SVRI)、心排指数(CI)、脉压差变异(PPV)、压力升支最大速率(dp/dtmax)、心动周期效率(CCE)、脉搏氧饱和度(SpO2).结果:患儿SctO2在T1、T2、T3、T4、T5、T7点与年龄、体质量、身高、BSA差异有统计学意义(P＜0.01).患儿SctO2在T4、T5两点差异有统计学意义(P＜0.01),而T4与T5比较差异无统计学意义.与T5点比较,T6点SBP、DBP、CI、SVI、CCE、dp/dtmax差异均有统计学意义(P＜0.01),而PPV、SVRI明显下降T5点(P＜0.01),T5、T6两点SctO2的变化值与CI、SVI的变化值有明显正相关性,相关系数分别(0.361、0.380,P＜0.05).与T2比较,T6点CI、SctO2差异无统计学意义.结论:SctO2与年龄和体表面积有密切关系.体外循环,特别是脱离体外循环前后对脑氧供产生不利影响.改良超滤使脑氧供明显增加并恢复到体外循环前水平.