CrSO2联合Pcv-aCO2对发绀型婴幼儿心脏手术后ICU停留时间的预测意义

Potential of CrSO2 combined with Pcv-aCO2 to predict length of stay in ICU after cardiac surgery in cyanotic infants

目的探究脑氧饱和度(cerebral oxygen saturation,CrSO2)联合中心静脉动脉二氧化碳分压差(central venous arterial carbon dioxide partial pressure difference,Pcv-aCO2)对发绀型婴幼儿心脏手术后ICU停留时间的预测意义。方法选取2018年6-12月在解放军总医院第七医学中心心肺转流(cardiopulmonary bypass,CPB)下接受心脏手术的0~1岁发绀型先心病患儿30例,分别于气管插管开放动静脉后(t1)、升主动脉夹闭后5 min(t2)、升主动脉开放后5 min(t3)、CPB结束(t4)、CPB结束后3 h(t5)、CPB结束后8 h(t6)、CPB结束后24 h(t7)记录CrSO2、动脉血二氧化碳分压(Pa CO2)、中心静脉血二氧化碳分压(Pcv CO2),动脉血孔酸(Lac)、动脉血氧饱和度(SaO2)、动脉血红蛋白(Hb)、平均动脉压(MAP)、温度氧咽温(T)并计算Pcv-aCO2;记录术后ICU停留时间。比较S组(ICU停留时间≤9 d)、L组(ICU停留时间>9 d)的患儿围术期Lac、CrSO2、Pcva CO2、SaO2、Hb、MAP、T的差异,分析Lac、CrSO2、Pcv-aCO2对发绀型婴幼儿心脏手术后ICU停留时间的预测意义。结果S组、L组两组患儿Lac在t1、t2、t3、t4、t5、t6、t7差异均无统计学意义;与S组相比,L组CrSO2在t1、t2、t3、t4明显降低[(53.33±4.38)%&(59.33±4.38)%、(56.83±3.51)%&(63.00±3.67)%、(47.48±5.65)%&(52.51±2.54)%、(44.58±2.42)%&(49.44±3.60)%],t5、t6、t7两组患儿CrSO2差异无统计学意义;与S组相比,L组Pcv-aCO2在t1、t2、t3、t4差异无统计学意义(P>0.05),在t5、t6、t7明显增高[(16.67±5.28)mm Hg&(9.63±3.98)mm Hg、(21.83±6.15)mm Hg&(12.71±3.10)mm Hg、(13.00±2.65)mm Hg&(7.36±3.03)]。S组和L组各时间点Pa CO2、SaO2、Hb、MAP、T比较,差异均无统计学意义。结论CPB期间CrSO2降低、CPB结束后Pcv-aCO2升高对ICU停留时间延长有预测作用。

Objective To investigate the potential of cerebral oxygen saturation(CrSO2)combined with central venous arterial carbon dioxide partial pressure difference(Pcv-aCO2)to predict the length of stay in the ICU for cyanotic infants after cardiac surgery.Methods Thirty children of 0-1 year old with cyanotic congenital heart disease who underwent cardiac surgery under cardiopulmonary bypass(CPB)between June and December 2018 in the Seventh Medical Center of Chinese PLA General Hospital were selected.CrSO2,arterial blood carbon dioxide partial pressure(PaCO2),central venous blood carbon dioxide partial pressure(PcvCO2)、Lac、SaO2、Hb、MAP and T of these patients were recorded immediately after tracheal intubation and open arteriovenous(t1),5 minutes after ascending aortic clamping(t2),5 minutes after the ascending aorta was opened(t3),at the end of CPB(t4),3 h after the end of CPB(t5),8 h after the end of CPB(t6),24 h after the end of CPB(t7).Pcv-aCO2 was calculated while postoperative length of ICU stay was recorded.The difference of perioperative Lac,CrSO2 Sa O2、Hb、MAP、T and Pcv-aCO2 was compared between group S(length of stay in the ICU≤9 days)and group L(length of stay in the ICU>9 days).The extent to which CrSO2 combined with Pcv-aCO2 could help predict the length of stay in the ICU for cyanotic infants after cardiac surgery was analyzed.Results There was no significant difference in Lac between group S and group L at t1,t2,t3,t4,t5,t6 or t7.Compared with group S,CrSO2 of group L was significantly reduced at t1,t2,t3,and t4[(53.33±4.38)%&(59.33±4.38)%,(56.83±3.51)%&(63.00±3.67)%,(47.48±5.65)%&(52.51±2.54)%,(44.58±2.42)%&(49.44±3.60)%],but there was no significant difference in CrSO2 at t5,t6 and t7.Compared with group S,Pcv-aCO2 in group L was not significantly different at t1,t2,t3,and t4,but increased significantly at t5,t6,and t7[(16.67±5.28)mm Hg&(9.63±3.98)mm Hg,(21.83±6.15)mm Hg&(12.71±3.10)mm Hg,(13.00±2.65)mm Hg&(7.36±3.03)].There was no significant difference in PaCO2,Sa O2,Hb,MAP and T between group S and group L at each time point.Conclusions The decrease of CrSO2 during CPB and the increase of Pcv-aCO2 after CPB can help predict the extension of length of stay in the ICU.