2018 年第 4 期 第 13 卷

不同年龄室间隔缺损修补术患儿麻醉诱导期间不同潮气末二氧化碳分压对局部脑氧饱和度和血流动力学的影响

Effect of end-tidal carbon dioxide partial pressure on cerebral oxygen saturation and hemodynamics during anesthesia induction in children undergoing ventricular septal defect repair

作者：汪晓南韩丁杨彦伟李刚欧阳川

英文作者：

单位：100029首都医科大学附属北京安贞医院麻醉中心

英文单位：

关键词：室间隔缺损；发病年龄；二氧化碳；脑氧饱和度；血流动力学

英文关键词：

• 摘要：

• 目的    探讨不同年龄室间隔缺损（VSD）修补术患儿麻醉诱导期间不同潮气末二氧化碳分压（PETCO2）对局部脑氧饱和度（rScO2）和血流动力学的影响。方法    选取2017年4—5月于首都医科大学附属北京安贞医院行择期VSD修补术患儿44例，按年龄分为≥6个月组（24例）和＜6个月组（20例）。入室全身麻醉气管插管后，建立桡动脉血压监测并使用MostCare血流动力学监测仪，使用Fore-Sight连续监测右侧额部rScO2。调整机械通气参数，分别使PETCO2依次维持在30（P1）、35（P2）、40（P3）、45（P4）mmHg（1 mmHg=0.133 kPa）状态。记录P1、P2、P3、P4状态时rScO2、心率、收缩压、重脉压与舒张压的差值、每搏指数、心排血指数、体循环阻力指数、脉压变异度。结果    随PETCO2升高，2组rScO2均明显升高［＜6个月组P1、P2、P3、P4状态时rScO2分别为（65±3）%、（69±3）%、（74±3）%、（77±4）%；≥6个月组P1、P2、P3、P4状态时rScO2分别为（71±6）%、（74±6）%、（78±5）%、（80±4）%］（均P＜0.001）；随PETCO2变化，＜6个月组rScO2变化幅度大于≥6个月组（P=0.011）。随PETCO2升高，≥6个月组收缩压、心排血指数、脉压变异度下降，＜6个月组体循环阻力指数下降，≥6个月组和＜6个月组心率均先下降后上升（均P＜0.05）。≥6个月组收缩压高于＜6个月组（P=0.024），其余参数组间比较差异均无统计学意义（均P＞0.05）。结论    VSD患儿在麻醉诱导阶段，随着PETCO2变化脑氧合和血流动力学变化反应良好，年龄较小患儿因脑血管功能储备有限，脑氧合受PETCO2波动的影响更大。

• Objective    To investigate the effect of end-tidal carbon dioxide partial pressure(PETCO2) on cerebral oxygen saturation(rScO2) and hemodynamics during anesthesia induction in children undergoing ventricular septal defect（VSD） repair. Methods    A total of 44 children undergoing VSD repair from April to May 2017 in Beijing Anzhen Hospital, Capital Medical University were divided into ≥6 months group（n＝24） and ＜6 months group（n＝20）. Radial artery pressure was monitored by the MostCare hemodynamic device and right frontal rScO2 was monitored by the Fore-Sight device during general anesthesia. PETCO2 was maintained at 30(P1), 35(P2), 40(P3), 45(P4) mmHg; rScO2, heart rate(HR), systolic pressure, dicrotic pressure, diastolic pressure, stroke volume index, cardiac index(CI), systemic vascular resistance index(SVRI) and pulse pressure variation(PPV) were recorded at P1, P2, P3, P4. Results   rScO2 significantly increased with PETCO2 in both groups［rScO2 of ≥6 months group at P1, P2, P3, P4 was （65±3）%,（69±3）%,（74±3）%,（77±4）%； rScO2 of ＜6 months group at P1, P2, P3, P4 was （71±6）%,（74±6）%,（78±5）%,（80±4）%］(P＜0.001). Variation amplitude of rScO2 in ＜6 months group was more significant than that in ≥6 months group（P=0.011）. Systolic pressure, CI and PPV decreased with the increase of PETCO2 in ≥6 months group; SVRI decreased with the increase of PETCO2 in ＜6 months group; HR decreased first then increased in both groups（all P＜0.05）. Systolic pressure in ≥6 months group was significantly higher than that in ＜6 months group(P=0.024); there was no statistical differences of other parameters between groups（P＞0.05）. Conclusion    sVariations of rScO2 and hemodynamics during anesthesia induction are tolerable in children undergoing VSD repair. Due to limited cerebral vascular function reserve, the cerebral oxygenation in young children is more affected by the fluctuation of PETCO2.