不同潮气末二氧化碳分压对室间隔缺损婴儿麻醉诱导期间局部肾氧饱和度的影响

Variation of end-tidal carbon dioxide partial pressure on regional renal oxygen saturation during anesthesia induction in infants undergoing ventricular septal defect repair

目的:比较不同潮气末二氧化碳分压(PETCO2)对室间隔缺损(VSD)婴儿麻醉诱导期间,局部肾氧饱和度(rSkO2)和脑氧饱和度(rScO2)的影响。方法:本研究共纳入全麻下行心室间隔缺损修补术的婴儿44例。通过MostCare监测仪分析桡动脉或股动脉压力波形,连续监测rSkO2和rScO2。调整麻醉呼吸机通气参数,分别使PETCO2依次维持在30(P1)、35(P2)、40(P3)、45(P4)mmHg。记录各时点rSkO2、rScO2、HR、SBP、DBP、重脉压(Pdic)、重脉压与舒张压的差值(Pdic-a)、心每搏量指数(SVI)、心排指数(CI)、体循环阻力指数(SVRI)、最大压力梯度(dp/dtmax)和脉压变异度(PPV)。结果:随着PETCO2升高,rScO2、SVI显著升高分别为(F=47.721,P<0.001,F=8.767,P<0.001);而rSkO2、DBP、Pdic、HR、PPV、SVRI显著下降分别为(F=43.896,P<0.001,F=35.624,P<0.001,F=35.638,P<0.001,F=45.815,P<0.001,F=10.800,P<0.001,F=5.576,P<0.001)。PETCO2与rSkO2呈明显负相关(r=-0.175,P=0.020),与rScO2呈明显正相关(r=0.598,P<0.001),与PPV呈明显负相关(r=-0.308,P<0.001)。Pdic-a与PPV呈明显负相关(r=-0.295,P<0.001)。结论:VSD婴儿在麻醉诱导阶段,随着潮气末二氧化碳分压的增加,脑氧合显著增加,肾氧合下降,但能满足肾脏灌注。在血流动力学正常状态下,脑氧合变化受血二氧化碳分压的影响,肾氧合受血流动力学变化的影响。

Objective: To investigate the variation of end-tidal carbon dioxide partial pressure ( PET CO2 ) on renal oxygen saturation ( rSkO2 ) and cerebral oxygen saturation( rScO2) during anesthesia induction in infants undergoing ventricular septal defect ( VSD) repair. Methods: A total of 44 infants undergoing VSD repair were enrolled. Radial or femoral artery pressure was monitored by MostCare hemodynamic device. rScO2 and rSkO2 were monitored by the Fore-Sight device continuously and respectively during general anesthesia. By adjusting mechanical ventilation parameters,PET CO2 were maintained at 30( P1 ),35( P2 ),40( P3 ),45( P4 ) mmHg respectively. rScO2 ,rSkO2 ,HR,SBP,Pdic,Pdic-a,SVI,CI,SVRI,dp /dtmax and PPV were recorded at P1 ,P2 ,P3 ,P4.Results: With the increase of PETCO2 , rScO2 significantly increased( F= 47. 721,P <0. 001),while rSkO2 significantly decreased( F= 43. 896,P<0. 001). DBP decreased with the increase of PET CO2 ( F= 35. 624,P<0. 001). Pdic decreased with the increase of PET CO2 ( F = 35. 638,P< 0. 001). HR decreased with the increase of PETCO2 ( F= 45. 815,P<0. 001). PPV decreased with the increase of PETCO2 ( F = 10. 800,P<0. 001). SVI increased with the increase of PETCO2 ( F = 8. 767,P<0. 001). SVRI decreased with the increase of PET CO2 ( F = 5. 576,P< 0. 001). Change in PET CO2 was negatively correlated with rSkO2 ( r =-0. 175,P= 0. 020) and PPV( r =- 0. 308,P < 0. 001) and positively correlated with rScO2 ( r = 0. 598,P < 0. 001). Change in Pdic - a was negatively correlated with PPV( r =- 0. 295,P< 0. 001). Conclusions: In infants undergoing VSD repair, rScO2 significantly increased,whereas rSkO2 significantly decreased as the increase of PETCO2 with tolerable kidney perfusion during anesthesia induction. Under normal hemodynamic conditions, rScO2 is mainly affected by PETCO2 changes and rSkO2 is mainly affected by hemodynamic changes.