肺保护性通气策略在新生儿胸腔镜手术中对脑氧饱和度的影响

Effect of Pulmonary Protective Ventilation on Cerebral Oxygen Saturation during Thoracoscopic Surgery in Neonates

目的 探讨肺保护性通气策略(PPVS)在新生儿胸腔镜手术中对患儿脑氧饱和度(cSO_2)的影响。方法 选取行先天性食道闭锁/气管食管瘘(EA/TEF)和先天性膈疝(CDH)修补术的新生儿共20例,随机均分为保护性通气组(P组)和传统通气组(C组,即对照组)。诱导插管,建立人工气胸。调整呼吸参数,P组以PPVS使动脉血二氧化碳分压(PaCO_2)<80 mmHg。C组以常规通气方式,使PaCO_2维持在35~45 mmHg。取插管机械通气后(T0)、气胸后30 min(T1)、气胸后60 min(T2)、气胸后90 min(T3)和气胸解除后30 min(T4)共5个观测时点,行动脉采血分析,同时以近红外光谱仪测量cSO_2。结果 T1~T3时点P组患儿的PaCO_2明显高于C组,动脉血气pH值明显低于C组(P<0.05),T1~T4各时点两者PaO_2均无统计学差异(P>0.05)。在T1~T3时点P组cSO_2显著低于C组(P<0.05)。T4时点2组PaCO_2、动脉血pH值差异无统计学意义(P>0.05)。结论 PPVS在新生儿胸腔镜手术中产生的高碳酸血症及酸中毒可导致一过性cSO_2降低。

Objective To explore the effect of pulmonary protective ventilation(PPV)on cerebral oxygen saturation(cSO2)in neonates during thoracoscopic surgery.Methods We selected 20 neonates with congenital esophageal atresia or with esophageal atresia/tracheoesophageal fistula(EA/TEF)and congenital diaphragmatic hernia(CDH).All neonates were randomly divided into the protective ventilation group(group P)and traditional ventilation group(group C).Artificial pneumothorax was established after endotracheal intubation.After the adjustment of breathing parameters,PaCO2 was maintained at<80 mmHg with PPV.For group C,the PaCO2 was maintained between 35-45 mmHg,which is same as the traditional ventilation parameter.The cSO2 in the arterial blood was examined at 5 time points using near-infrared spectrometry.Results At T1-T3,the PaCO2 of arterial blood for group P was significantly higher than that for group C(P<0.05),whereas the pH of arterial blood gas for group P was significantly lower than that for group C(P<0.05).At T1-T4,the PaO2 of arterial blood was not significantly different between the two groups(P>0.05).At T1-T3,the brain oxygen saturation was significantly lower in group P than that in group C(P<0.05).At T4,there was no significant difference in the values of pH and PaCO2 of arterial blood between the two groups(P>0.05).Conclusion Hypercapnia and acidosis caused by PPV in neonatal thoracoscopic surgery can lead to lower cSO2.