患儿主动脉弓部手术中局部脑氧饱和度和躯体氧饱和度的变化

Comparison of cerebral and somatic tissue oxygenation during pediatric aortic arch repair surgery

目的观察和比较局部脑氧饱和度(SctO2)和躯体氧饱和度(SstO2)在患儿主动脉弓部手术中的变化。方法收集2015年1月至2017年2月收治的主动脉弓缩窄(coarctation of aorta,COA)或主动脉弓离断(interruption of aortic arch,IAA)合并心内畸形,择期在心肺转流(cardiopulmonary bypass,CPB)联合选择性脑灌注(selective cerebral perfusion,SCP)下行一期矫治术的患儿21例,男16例,女5例,年龄12 d至11个月,体重3~6 kg ASA Ⅲ或Ⅳ级。采用全身麻醉和常规监测,同时持续监测右额部和背部局部组织氧饱和度,分别为SctO2和SstO2。于诱导时(T0)、切皮时(T1)、CPB开始(T2)、SCP开始(T3)、停SCP(T4)、主动脉开放(T5)、停CPB(T6)、术毕(T7)时记录SctO2、SstO2、中心静脉氧饱和度(ScvO2)。结果与T0时比较,T2、T5、T6时SctO2明显降低(P<0.05)。T0—T4时SctO2明显高于SstO2(P<0.05);T5—T7时SctO2明显低于SstO2(P<0.05)。SctO2与ScvO2的Pearson相关系数r=0.80(P<0.05)。结论在患儿主动脉弓部手术中,SctO2和SstO2差异和变化较大,可以依据其变化趋势,指导术中精细化调控。

Objective To investigate the comparison of cerebral tissue oxygen saturation(SctO2) and somatic tissue oxygen saturation(SstO2) during pediatric aortic arch surgery. Methods Twenty-one cases undergoing corrective surgery of coarctation of aorta or interruption of aortic arch from January 2015 to February 2017 were collected. There were 16 males and 5 females. The age ranged from 12 days to 11 months with the ASA physical status Ⅲ or Ⅳ. All children underwent surgical procedures under cardiopulmonary bypass(CPB)and selective cerebral perfusion(SCP). The conventional general anesthesia induction and monitoring were conducted, and the cerebral tissue oxygen saturation(SctO2) and somatic tissue oxygen saturation(SstO2) were continuously measured. The parameters including SctO2, SstO2, ScvO2 of different time points were recorded separately induction(T0), skin incision(T1), at the beginning of CPB(T2), beginning of SCP(T3), the end of SCP(T4), aortic opening(T5), the end of CPB(T6), the end of operation(T7). Results The SctO2 were significantly lower with statistic difference at T2, T5, T6 compared with that at T0 (P < 0.05). The SctO2 were higher than SstO2 at T0-T4(P < 0.05), and lower than SstO2 at T5-T7(P < 0.05). Pearson correlation coefficient between SctO2 and ScvO2 is 0.80(P < 0.05). Conclusion SctO2 and SstO2 have great differences and changes during pediatric aortic arch surgery. According to the changing trend, continual monitoring and control of SctO2 and SstO2 may be used as a guide to make more precise interventions.