2023 年第 2 期 第 18 卷

不同水平动脉血二氧化碳分压对室间隔缺损修补术婴儿心脑保护作用的研究

The cardiocerebral protection of different levels of partial pressure of arterial carbon dioxide for the infants undergoing ventricular septal defect repair

作者：范凡1郭颖1欧阳川2刘迎龙2谢思远3柏松1童峰1郑佳1郭张科1李奇林1李晓峰1

英文作者：Fan Fan1 Guo Ying1 Ouyang Chuan2 Liu Yinglong2 Xie Siyuan3 Bai Song1 Tong Feng1 Zheng Jia1 Guo Zhangke1 Li Qilin1 Li Xiaofeng1

单位：1首都医科大学附属北京儿童医院国家儿童医学中心心脏外科，北京100045；2首都医科大学附属北京安贞医院小儿心脏中心，北京100029；3首都儿科研究所麻醉科，北京100020

英文单位：1Department of Cardiac Surgery Beijing Children′s Hospital Capital Medical University National Center for Children′s Health Beijing 100045 China; 2Pediatric Cardiac Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 3Department of Anesthesia Capital Institute of Pediatrics Beijing 100020 China

关键词：先天性心脏病；器官损伤；二氧化碳

英文关键词：Congenitalheartdisease;Organinjury;Carbondioxide

• 摘要：

• 目的 探究不同水平动脉血二氧化碳分压（PaCO2）对室间隔缺损修补术婴儿的心脑保护作用。方法 回顾性分析首都医科大学附属北京安贞医院2017年5月至2018年5月83例行室间隔缺损修补术婴儿的资料。采用呼气末二氧化碳分压(PETCO2)作为间接的、持续性指标来反映PaCO2，记录术前（T1）、切心包（T2）、停体外循环（T3）、停超滤（T4）及术毕（T5）时点的PETCO2，除T3时点PaCO2不受呼吸条件影响外，在其余时点PETCO2为30~＜40 mmHg（1 mmHg=0.133 kPa）的婴儿为低二氧化碳组（LP组，34例），PETCO2为40~＜50 mmHg的婴儿为高二氧化碳组（HP组，49例）。记录实验室指标，T1、T4时点动脉血气分析结果，T1~T5时点呼吸参数、局部脑氧饱和度（rScO2）、脑血流参数及血流动力学参数。结果 术后1 d，2组肌酸激酶同工酶水平均高于术前3 d，但HP组低于LP组（P＜0.05）。HP组T1、T4时点PaCO2水平均高于LP组［（38±5）mmHg比（31±4）mmHg、（44±6）mmHg比（36±4）mmHg］（均P＜0.001）。HP组T1~T5时点分钟通气量、呼吸频率均低于LP组，PETCO2水平均高于LP组（均P＜0.05）。除T3时点外，HP组各时点rScO2、大脑中动脉平均流速均高于LP组，差异均有统计学意义（均P＜0.05）。Pearson相关性分析结果显示，行室间隔缺损修补术婴儿PETCO2与PaCO2呈正相关（P＜0.001）。结论 通过精准管理将PaCO2维持在正常偏高水平，可以安全有效地减轻室间隔缺损手术婴儿的心脑损伤。

• Objective To investigate the cardiocerebral protection of different levels of partial pressure of arterial carbon dioxide (PaCO2) for the infants undergoing ventricular septal defect (VSD) repair. Methods  From May 2017 to May 2018, data of 83 infants undergoing VSD repair in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. Partial pressure of end expiratory carbon dioxide (PETCO2) was used as an indirect and continuous index to reflect PaCO2. PETCO2 was recorded at before operation (T1), pericardiotomy (T2), stopping cardiopulmonary bypass (T3), stopping ultrafiltration (T4) and the end of operation (T5). Except that PaCO2 at T3 was not affected by respiratory conditions, infants with PETCO2 at 30-＜40 mmHg at other time points were divided into low carbon dioxide group (LP group, 34 cases), and infants with PETCO2 at 40-＜50 mmHg were divided into high carbon dioxide group (HP group, 49 cases). The laboratory indicators, arterial blood gas analysis at T1 and T4, respiratory parameters, regional cerebral oxygen saturation (rScO2), cerebral blood flow parameters and hemodynamic parameters at T1-T5 were recorded. Results  One day after operation, the levels of creatine kinase isoenzyme in both groups were higher than those 3 d before treatment, while the level in HP group was lower than that in LP group (P<0.05). Levels of PaCO2 at T1 and T4 in HP group were higher than those in LP group ［（38±5）mmHg vs （31±4）mmHg,（44±6）mmHg vs （36±4）mmHg］(both P<0.001). At T1-T5, minute ventilation and respiratory rate in HP group were lower than those in LP group and levels of PETCO2 were higher than those in LP group (all P<0.05). The rScO2 and average velocity of middle cerebral artery in HP group were higher than those in LP group at T1-T5 except T3 (all P<0.05). Pearson correlation analysis showed that PETCO2 was positively correlated with PaCO2 in infants undergoing VSD repair (P<0.001). Conclusion  As a safe and effective way, precision management on higher PaCO2 in the normal range can attenuate cardiocerebral injury in infants undergoing VSD repair.