不同呼气末二氧化碳分压对室间隔缺损婴儿麻醉诱导期间局部肠氧饱和度的影响

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

目的:比较不同呼气末二氧化碳分压(PETCO2)对室间隔缺损(VSD)婴儿麻醉诱导期间,局部肠氧饱和度(rSiO2)的影响。方法:本研究共纳入全麻下行心VSD修补术的婴儿65例。通过MostCare监测仪分析有创动脉压力波形,连续监测rSiO2、肾氧饱和度(rSkO2)和脑氧饱和度(rSCO2)。调整麻醉呼吸机通气参数,分别使PETCO2依次维持在30(T1)、35(T2)、40(T3)、45(T4)mmHg(1 mmHg=0.133 kPa)。记录各时点rSiO2、rSkO2、rScO2、心排指数(CI)、SBP、DBP、重脉压(Pdic)、HR、重脉压与舒张压的差值(Pdic-a)、心每搏量指数(SVI)、体循环阻力指数(SVRI)、最大压力梯度(dp/dt max)和脉压变异度(PPV)。结果:随着PETCO2升高,rScO2、SVI显著升高(P<0.001);而rSiO2、DBP、Pdic、HR、PPV显著下降(P<0.001)。PETCO2与rSkO2、rSiO2呈明显负相关(P<0.001),与rScO2呈明显正相关(P<0.001),与PPV呈明显负相关(P<0.001)。Pdic-a与PPV呈负相关(P=0.023)。结论:VSD患儿在麻醉诱导期间,随着呼气末二氧化碳分压的增加,肠氧合下降,但能满足肠组织灌注。肠氧合除与PETCO2相关,还与脑氧合、肾氧合及血流动力学相关。

Objective:To investigate the variation of end-tidal carbon dioxide partial pressure(PET CO2)on intestinal oxygen saturation(rSiO2)during anesthesia induction in infants undergoing ventricular septal defect(VSD)repair.Method:A total of 65 infants undergoing VSD repair were enrolled.Radial or femoral artery pressure was monitored by MostCare hemodynamic device.rSiO2、rScO2 and rSkO2 were monitored by the Fore-Sight device continuously and respectively during general anesthesia.By adjusting mechanical ventilation parameters,P ET CO2were maintained at 30(T1),35(T2),40(T3),45(T4)mmHg respectively.rSiO2,rSiO2,rScO2,CI,SBP,DBP,Pdic,HR,Pdic-a,SVI,SVRI,dp/dtmax and PPV were recorded at T1,T2,T3,T4.Results:With the increase of PETCO2,rScO2 and SVI significantly increased(P<0.001).RSiO2,DBP,Pdic,HR,PPV decreased significantly(P<0.001).Change in PETCO2 was significantly negatively correlated with rSiO2 and rSiO2(P<0.001)and significantly positively correlated with rScO2(P<0.001);Change in PETCO2was significantly negatively correlated with PPV(P<0.001).Change in rSiO2was positively correlated with rSkO2(P<0.001),and Change in Pdic-a was negatively correlated with PPV(P=0.023).Conclusions:In infants undergoing VSD repair,rSiO2significantly decreased as the increase of PETCO2 with tolerable intestinal perfusion during anesthesia induction.Besides PET CO2,intestinal oxygenation is also related to cerebral oxygenation,renal oxygenation and hemodynamics changes.