局部脑氧饱和度监测在右侧腋下小切口心脏手术中的应用

Application of regional cerebral oxygen saturation monitoring in heart surgery through right vertical infra-axillary thoracotomy

目的观察局部脑氧饱和度(rSO2)在右侧腋下小切口心脏手术中的变化。方法2018年1~5月,选择行房间隔缺损(ASD)、室间隔缺损(VSD)修补术患儿各40例。VSD修补手术患儿采用左侧90度卧位,ASD修补手术患儿采用左侧90度卧位及头低位45度。记录患儿的一般资料以及在术前(T1)、诱导至心肺转流(CPB)开始期间(T2)、CPB降温期间(T3)、CPB降温末至CPB开始复温(T4)、CPB开始复温至CPB停机(T5)、CPB停机后20min(T6)6个时间段的双侧rSO2。结果全组患儿均手术顺利。其中ASD患儿组,在左侧不同时段内的比较,T3、T4、T5时间段的rSO2明显低于T1(P<0.05);而右侧不同时段内rSO2的比较,发现T3、T4、T5、T6明显低于T1(P<0.05);不同时段左、右侧的rSO2对比均无统计学差异(P>0.05)。而VSD患儿组,左侧不同时段内rSO2的比较,发现T3、T5明显低于T1(P<0.05);而右侧不同时段rSO2的比较,发现T3、T4、T5、T6均明显低于T1(P<0.05);在不同时段内,T3、T4、T5、T6的rSO2右侧均明显低于左侧(P<0.05)。结论rSO2在右侧腋下小切口心脏手术中监测有临床意义,CPB过程中rSO2会下降,停止CPB后逐步恢复至术前水平。单纯左侧90度卧位会导致左侧rSO2较右侧高。

Objective To explore the changes of regional cerebral oxygen saturation (rSO2 ) during cardiopulmonary bypass (CPB) through right vertical infra-axillary thoracotomy (RVIAT). Methods 80 cases undergoing cardiac surgery from January 2018 to May 2018 were enrolled in the study. Among them, there were 40 cases of ventricular septal defect (VSD)who maintained 90-degree lateral decubitus position and 40 cases of atrial septal defect (ASD) patients who kept 90-degree lateral decubitus and 45-degree head-down position. The rSO2 levels were recorded at the following time points: before surgery (T1), before anesthesia induction (T2), from induction to the beginning of CPB (T3), from the beginning of CPB to the end of nose temperature cooling(T4), from the end of nose temperature cooling to the beginning of rewarming (T5), and from the beginning of rewarming to the end of CPB (T6). All these data were analyzed by SPSS statistical software. Results All Patients underwent surgery successfully. In ASD group, compared with T1, rSO2 levels of the left side at T3, T4 and T5 were significantly lower ( P <0.05) and so as the rSO2 levels of the right side at T3, T4, T5 and T6 ( P <0.05), while there was no significant difference between the left and right sides at all time points ( P > 0.05). In VSD group, compared with T1, rSO2 level of the left in T3, T5 was significantly lower than that of T1 ( P <0.05), however, in the right side, the rSO2 levels in T3, T4, T5, T6 were obviously lower than that of T1( P <0.05). Besides, rSO2 levels on the left side were significantly lower than those on the right side during T3, T4, T5 and T6 ( P <0.05). Conclusion Monitoring of rSO2 in minimally invasive cardiac surgery for children has great clinical significance. The rSO2 decreases during CPB and gradually returns to the preoperative level after CPB. 90-degree lateral decubitus position may lead to higher rSO2 on the left side.