小儿体外循环下心脏手术围术期脑氧供需监测研究现状

Current status of monitoring of cerebral oxygen supply and demand during perioperative cardiac surgery in children with extracorporeal circulation

小儿体外循环(CPB)下心内直视手术常伴有术后神经损伤,加强术中脑血流和脑氧合的监测有助于及时发现脑缺血缺氧不良事件,指导医师及时调整灌注参数,显著降低术后神经损伤的发生率,改善患儿预后。经颅多普勒超声(TCD)通过对脑血流速度的监测直接反映脑灌注、间接反映脑氧供需情况,颈静脉球血氧饱和度(SjbO2)和脑局部氧饱和度(CrSO2)通过对大脑半球脑氧合的监测直接反映脑氧供需情况,因此小儿心脏手术围术期联合监测这些指标可全面反映脑氧供需状况,预防缺血缺氧性神经损伤。本文就近年来TCD、SjbO2和CrSO2在小儿CPB下心脏手术围术期脑氧供需监测方面的研究现状进行综述,为预防术后神经损伤提供依据。

Cardiopulmonary bypass(CPB)is often accompanied by postoperative nerve injury in children.Studies have shown that monitoring of cerebral blood flow and cerebral oxygenation during enhanced operation can help to detect the adverse events of cerebral ischemia and hypoxia in time,guide physicians to adjust perfusion parameters in time,and can significantly reduce the incidence of postoperative nerve injury and improve the prognosis of children.Transcranial doppler(TCD)can directly reflect cerebral perfusion and indirectly reflect cerebral oxygen supply and demand by monitoring cerebral blood flow velocity,and jugular blood oxygen saturation(SjbO2)and cerebral local oxygen saturation(CrSO2)directly reflect cerebral oxygen supply and demand by monitoring cerebral oxygenation in the cerebral hemisphere.Therefore,the combined monitoring of these indexes during the perioperative period of cardiac surgery in children can reflect the cerebral oxygen supply and demand in an all-round way,and prevent the ischemic and hypoxic nerve injury.The research status has been reviewed in present paper of TCD,SjbO2 and CrSO2 in monitoring cerebral oxygen supply and demand during perioperative cardiac surgery in children with CPB in order to provide evidence for the prevention of postoperative nerve injury.