2020 年第 4 期 第 15 卷

不同年龄患儿室间隔缺损修补术中脑氧饱和度变化研究

Changes of cerebral oxygen saturation during ventricular septal defect repair in children with different ages

作者：崔博群1谢思远2马骏1欧阳川1

英文作者：Cui Boqun1 Xie Siyuan2 Ma Jun1 Ouyang Chuan1

单位：1首都医科大学附属北京安贞医院麻醉中心100029；2首都儿科研究所附属儿童医院麻醉科，北京100000

英文单位：1Anaesthesia Central Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Anaesthesiology Children′s Hospital Capital Institute of Pediatrics Beijing 100000 China

关键词：室间隔缺损；脑损伤；脑氧饱和度；认知功能；低龄

英文关键词：Ventricularseptaldefect;Cerebralinjury;Regionalcerebraloxygensaturation;Cognitivefunction;Lowage

• 摘要：

• 【摘要】目的    应用近红外光谱法监测区域脑组织氧饱和度（rScO2），分析不同年龄行室间隔缺损(VSD)修补术患儿在体外循环前后和改良超滤前后rScO2的变化和血流动力学变化的相互关系。方法    选择2017年7月至2018年4月首都医科大学附属北京安贞医院收治的择期在心肺旁路下行VSD根治术的患儿46例，其中年龄≤6个月25例（S组），>6个月21例（L组）。入室全身麻醉气管插管后，监测麻醉诱导后（T0）、开心包时（T1）、体外循环全流量后5 min（T2）、减辅助流量时（T3）、脱机时（T4）、改良超滤结束时（T5）、术毕时（T6）各时点rScO2，于T0、T1、T4、T5、T6时点记录收缩压、心排血指数（CI）、每搏指数、外周血管阻力指数（SVRI）、动脉压力升支最大斜率（dp/dtmax）、脉压变异度（PPV）、重脉压与舒张压差值。结果    组间比较，除T2时，其余各时点S组rScO2均显著低于L组［T0、T1、T3、T4、T5、T6：（71±7）%比（78±7）%、（71±6）%比（80±6）%、（66±4）%比（69±4）%、（63±9）%比（72±10）%、（70±8）%比（77±9）%、（71±8）%比（78±7）%］，差异均有统计学意义（P<0.01或P<0.05）。组内比较，与T4相比，T5时2组rScO2、CI、每搏指数、dp/dtmax均明显增加（均P<0.01），SVRI、PPV均明显降低（P<0.05或P<0.01）。结论    VSD修补手术中，年龄越小rScO2越低。体外循环后，容量和心功能变化对rScO2有明显影响。

• 【Abstract】Objective    To observe the changes of regional cerebral oxygen saturation(rScO2) monitored by near-infrared spectroscopy and hemodynamic indexes before and after cardiopulmonary bypass(CPB) and modified ultrafiltration(MUF) in children of different ages undergoing ventricular septal defect（VSD） repair. Methods    From July 2017 to April 2018, 46 children undergoing radical surgery of VSD with CPB were enrolled at Beijing Anzhen Hospital, Capital Medical University. They were divided into age≤6 months group(group S, 25 cases) and age>6 months group(group L, 21 cases). The value of rScO2 was monitored at following time points: after anesthesia induction(T0), during pericardium incision(T1), 5 mins after CPB with the maximum flow(T2), reducing auxiliary flow(T3), withdrawing CPB(T4), the end of MUF(T5) and after operation(T6). Systolic blood pressure, cardiac index, stroke index, systemic vascular resistance index(SVRI), maximum gradient of ascending artery pressure(dp/dtmax), pulse pressure variability(PPV), difference between heavy pulse pressure and diastolic blood pressure were monitored at T0, T1, T4, T5 and T6. Results    Mostly, rScO2 in group S were significantly lower than that in group L［T0, T1, T3, T4, T5, T6: （71±7）% vs （78±7）%, （71±6）% vs （80±6）%, （66±4）% vs （69±4）%, （63±9）% vs （72±10）%, （70±8）% vs （77±9）%, （71±8）% vs （78±7）%］(P<0.01 or P<0.05). In both groups there were higher rScO2, cardiac index, stroke index, dp/dtmax and lower PPV and SVRI at T5 compared with those at T4(P<0.01 or P<0.05). Conclusions    RScO2 decreases with age in children undergoing VSD repair. Changes in volume and cardiac function during CPB show obvious effect on rScO2.