婴幼儿室间隔缺损合并重度肺动脉高压术后心排量与氧代谢的变化规律

The rule of cardiac output and oxygen delivery/consumption during the postoperative period in the infants with severe VSD and Pulmonary artery hypertension

目的:总结分析婴幼儿期室间隔缺损合并重度肺动脉高压心脏直视术后心排量与氧供、氧耗的变化规律及临床意义。方法:室间隔缺损合并重度肺动脉高压患儿25例,男性15例,女性10例。年龄0.5～2.75(1.25±0.68)岁,体质量5～13.7(8.68±2.49)kg,术前经皮血氧饱和度(SPO2)0.95～0.99(0.97±0.70),超声心动图检查平均肺动脉压力65～82(67.86±21.35)mmHg(1 mmHg=0.133 kPa)。合并心脏畸形包括:房间隔缺损9例,动脉导管未闭5例,主动脉弓缩窄3例。麻醉时经颈内静脉置入4F Swan-Ganz漂浮导管,经桡动脉置入动脉测压管。分别于手术结束即刻、术后4 h、8 h、12h、24 h、48 h及72 h,由桡动脉及漂浮导管抽取动脉和混合静脉血标本行血气分析。热稀释法测定心排量(CO),PHLIPS M:8007 A计算心排指数(CL)、氧供指数(DO2I)、氧耗指数(VO2I)、氧摄取率(O2ER)。结果:①术后DO2I与VO2I显著相关,术后即刻呈线性依赖;②术后8 h CI、DO2I、VO2I最低;O2ER最高。结论:婴幼儿期室间隔缺损合并重度肺动脉高压,术后即刻存在着病理性氧供依赖,术后8 h既存在氧供不足又有氧耗下降,应积极提高心排量改善组织氧分。

Objective ：The purpose of this study the rule of the oxygen delivery and oxygen consumption during the postoperative period in the congenital heart disease infants with VSD and severe pulmonary artery hy- pertension. Methods：25 cases with VSD and Pulmonary artery hypertension, male 15, female 10, age 0. 5-2. 75 （ 1.25±O. 68） years old, weight 5-13.7 （8.68±2.49） kg. Preoperative percutaneous blood oxygen saturation 0. 95 -0. 99 （ 0. 97±0. 70）, echocardiography mean pulmonary artery pressure （mPAP） 65 - 82 mmHg（67. 86±21.35） mmHg. Combined with cardiac abnormalities include： ASD 9 cases, PDA 5 cases, CO-A 3 patients. All cases were taken surgery operation under the Intravenous/Inhalation Anesthesia and extra- corporeal circulation （ CPB ）. After induction of anesthesia, an arterial catheter was inserted into a radialis artery and a PA catheter （Swan-Ganz catheter 4F） was inserted via an internal jugular vein into pulmonary artery. Blood Samples of arterial and central venous blood were withdrawn at following times ： 30 minutes, and 4, 8, 12, 24, 48, 72 hours postoperation. The blood gas and arterial lactate levels were measured. Cardiac output was measured by thermodilution. The hemodynamic and oxygen metabolic changes were calculated by the PHLIPS M： 8007A mornitor. Results：postoperative 0 h significantly related; ~）postoperative 8 h CI, DO2 V02I minimum; O2ER supreme. Conclusion：The postoperation exist hypoxia in the infant with VSD and Pul- monary artery hypertension, postoperative 0 h DO2I and V02I have pathological dependence, 8 h the oxygen deliver shortage and oxygen consumption obstacle.