近红外光谱仪在婴幼儿肢体灌注术中监护的应用

Application of near-infrared spectroscopy on monitoring limb perfusion in infants and children

目的使用近红外光谱仪(NIRS)监测外周动脉置管对婴幼儿肢体肌肉氧饱和度(SmO2)的影响。方法选择2017年3—9月首都儿科研究所附属儿童医院行择期手术小于36月龄患儿共60例。全麻气管插管、动脉穿刺置管前后,使用NIRS监测并记录双侧肢体大鱼际肌或腓肠肌SmO2。以无置管肢体、置管肢体初始SmO2值作对照,观察置管肢体置管后SmO2的变化。结果置管前置管肢体与无置管肢体初始SmO2值比较差异无统计学意义(P>0.05)。置管后置管肢体SmO2降低,且低于无置管肢体,差异有统计学意义(P<0.001)。年龄<6月患儿SmO2下降程度>6~12月和>12~36月患儿;体重<10 kg患儿SmO2下降程度大于10~20 kg患儿,差异均有统计学意义(P<0.001)。结论NIRS可以较准确、实时反映动脉置管后肢体SmO2变化,使用NIRS监测有益于更精准地评估肢体灌注。年龄<6月及体重<10 kg的儿童需加强肢体灌注监护。

ObjectiveTo use near-infrared spectroscopy(NIRS)to monitor the effects of peripheral artery catheterization on limb muscle oxygen saturation(SmO2)in infants and children.MethodsTotally 60 children aged under 36 months receiving selective operation in Children's Hospital,Capital Institute of Pediatrics between March and September 2017 were selected.NIRS was used to monitor and record the SmO2 of muscle of thenar or gastrocnemius muscle on the limbs of both sides before and after trachea cannula and artery cannulation under general anesthesia.The original SmO2 values of the limbs with or without cannulation were taken as controls to observe the changes of SmO2 of the limbs with cannulation after cannulation.ResultsThere was no statistically significant difference in original SmO2 values of the limbs with or without cannulation before cannulation(P>0.05).The SmO2 values of the limbs with cannulation dropped after cannulation,which were lower than the values of the limbs without cannulation(P<0.001).The decreasing range of SmO2 values of the children aged under 6 months were larger than those of the children aged between 6 and 12 months and between 12 and 36 months;and the decreasing range of SmO2 values of the children weighing under 10 kg were larger than those of the children weighing between 10 and 20 kg(P<0.001).ConclusionsNIRS can accurately reflect the changes of SmO2 after artery cannulation in real time.NIRS used in monitoring helps to assess limb perfusion more precisely.Monitoring should be enhanced for limb perfusion in children aged under 6 months and weighing under 10 kg.