不同年龄儿童脊柱侧弯矫正术中局部脑氧饱和度的研究

Research of regional cerebral oxygen saturation during scoliosis surgery in children of different ages

目的探讨不同年龄儿童脊柱侧弯矫正术中局部脑氧饱和度(regional cerebral oxygen saturation,rScO_(2))的变化,以提高麻醉和手术的安全性。方法选取2018年3月至2019年9月首都医科大学附属北京儿童医院行脊柱侧弯矫正术的患儿60例,按年龄分为A组(≤6岁,20例)和B组(>6岁,40例)。分析两组麻醉诱导插管后(T_(1))、俯卧位后(T_(2))、切皮后(T_(3))、植入椎弓根螺钉(T_(4))、截骨(T_(5))、矫形(T_(6))和术毕(T_(7))7个时间点的双侧rScO_(2),并记录术中出血量、手术时间和麻醉时间。结果A组术中出血量(260.0 ml比680.0 ml)、晶体液使用量[(917.5±282.5)ml比(1671.3±478.0)ml]、手术时间(139.0 min比244.0 min)和麻醉时间(195.0 min比300.5 min)均低于B组,且A组术中自体血量低于B组(148.0ml比340.0 ml),差异有统计学意义(P<0.05)。T_(5)时A组LrScO_(2)和RrScO_(2)均低于B组,差异有统计学意义(P<0.05);其余各时间点两组LrScO_(2)和RrScO_(2)比较,差异均无统计学意义(P>0.05)。结论行脊柱侧弯后路矫形内固定术的低龄患儿较年长患儿截骨时rScO_(2)下降明显,需加强术中脑保护,以保证手术安全,减少术后并发症。

Objective To observe the changes of regional cerebral oxygen saturation(rScO_(2))in children with scoliosis correction of different age.Methods A total of 60 children who undergoing scoliosis correction in Beijing Children’s Hospital from March 2018 to September 2019 were divided into group A(≤6 years old,20 cases)and group B(>6 years old,40 cases).The value of rScO_(2) was recorded after induction of anesthesia(T,),after prone position(T_(2)),when cutting the skin(T_(3)),when implanting pedicle screws(T_(4)),when osteotomy(T_(5)),when correction(T_(6))and at the end of surgery(T_(7)).The amount of blood loss,operation time and anesthesia time were recorded.Results In group A,intraoperative bleeding volume(260.0 ml vs.680.0 ml),crystal infusion volume[(917.5±282.5)ml vs.(1671.3±478.0)ml],operation time(139.0 min vs.244.0 min)and anesthesia time(195.0 min vs.300.5 min)were lower than those of group B.The autologous blood volume of group A was lower than that of group B(148.0 ml vs.340.0 ml,P<0.05).LrScO,and RrScO_(2) of group A were lower than those of group B in T_(5)(P<0.05).There was no significant difference between the two groups of LrScO_(2) and RrScO_(2) at other time points(P>0.05).Conclusions The rScO_(2) of younger children undergoing scoliosis correction is lower than that of older children during osteotomy.Brain protection during operation should be strengthened in younger children to ensure surgical safety and reduce postoperative complications.