心血管手术患儿脑氧饱和度变化的影响因素

Influential factors of cerebral oxygen saturation in pediatric cardiovascular surgery

目的:探讨儿童先天性心脏病手术麻醉中脑氧饱和度下降的有效干预措施。方法:纳入28例行心脏手术患儿,丙泊酚3 mg/kg静脉注射加深麻醉后,记录浅麻醉时以及加深麻醉后1,2,3,4,5,10,15 min时的脑组织氧饱和度(cerebral tissue oxygen saturation,Sct O2),脑电双频指数(bispectral index,BIS),平均动脉压(mean arterial pressure,MAP),HR;浅麻醉时以及加深麻醉后5,10 min时的氧分压(arterial partial pressure of oxygen,Pa O2)、二氧化碳分压(arterial partial pressure of carbon dioxide,Pa CO2)、血红蛋白(hemoglobin,Hb)浓度;浅麻醉时以及加深麻醉后1,5,10,15 min时的大脑中动脉(middle cerebral artery,MCA)平均血流速度(mean flow velocity,Vm)、搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)、收缩峰速度与舒张末期速度比值(S/D)。分析Sct O2的变化情况及其影响因素。结果:丙泊酚加深麻醉后,与浅麻醉时相比Sct O2下降4.99%(95%CI:4.33%~5.65%,P>0.05);MAP,Pa O2,Pa CO2,Hb无明显变化(P>0.05);Vm加深麻醉后1,5,10 min较浅麻醉时下降且差异有统计学意义(P<0.05);多元线性回归分析结果显示MAP,HR,Pa CO2,MCA Vm的下降与Sct O2的下降正相关。结论:MAP,HR,Pa CO2,MCA Vm的下降为Sct O2的危险因素,避免以上因素下降,对维持Sct O2的稳定,避免脑氧供需失衡,预防神经系统并发症有重要意义。

Objective： To determine the intervention measures for the decrease of cerebral tissue oxygen saturation during anesthesia for the congenital heart disease in children. Methods： Twenty-eight children with cardiac surgery were enrolled. Anesthesia was deepened with propofol （3 mg/kg） intravenous injection. The data of cerebral tissue oxygen saturation（SctO2）, mean arterial pressure （MAP）, HR, bispectral index （BIS）, arterial partial pressure of oxygen （PaO2）, arterial partial pressure of carbon dioxide （PaCO2）, hemoglobin （Hb） and middle cerebral artery （MCA） mean flow velocity （Vm） at different points were collected after intravenous injection ofpropofol at 3 mg/kg. The changes of SctO2 and the influential factors were analyzed. Results： SctO2 decreased by 4.99% after deepen anesthesia, with 95% CI 4.33% to 5.65% （P〉0.05）. There was no significant differince in MAP, PaO2, PaCO2, and Hb between the time points after deepen anesthesia and the baseline （P〉0.05）. MCA Vm decreased obviously after deepen anesthesia for 1, 5, 10 min （P〈0.05）. The decrease in MAP, HR, PaCO2 and MCA Vm is positively correlated with the decrease in SctO2. Conclusion： The decrease of MAP, HR, PaCO2, and MCAVm is the risk factor for SctO2. To avoid the decrease, it needs to maintain the stability of SctO2 and prevent neurological complications.