Bichel T, Kalangos A, Rouge J C
Department of Anaesthesiology, University Hospital of Geneva, Switzerland.
Paediatr Anaesth. 1999;9(2):129-34. doi: 10.1046/j.1460-9592.1999.9220324.x.
In forty-two children undergoing cardiac surgery using hypothermic cardiopulmonary bypass (CPB), a gastric tonometer was used intraoperatively to estimate pHi, reflection of splanchnic perfusion. PHi monitoring was used to predict early postoperative complications. Intramucosal acidosis appeared after removal of the aortic clamp and remained after weaning of CPB. Fifteen children (group C) developed early postoperative life-threatening complications. Twenty-seven children (group NC) had no major complications. Retrospective data analysis showed a decrease of pHi during hypothermic CPB in the two groups but at completion of surgery, pHi was significantly lower in the group C (7.13 +/- 0.04 vs 7.31 +/- 0.001, P < 0.001). Bypass and aortic clamp times were also longer in group C and intraoperative core temperature lower. Continuous automated tonometer gas analysis appeared more accurate for the monitoring of acute haemodynamic and respiratory changes and should probably improve the predictive value of tonometry in the future. Tonometry is highly sensitive and represents an interesting and minimally invasive monitoring for critically ill children.
在42例接受低温体外循环心脏手术的儿童中，术中使用胃张力计评估反映内脏灌注情况的胃黏膜内pH值（pHi）。通过监测pHi来预测术后早期并发症。在松开主动脉钳夹后出现了黏膜内酸中毒，且在体外循环撤机后仍持续存在。15名儿童（C组）术后早期出现危及生命的并发症。27名儿童（非C组）未出现重大并发症。回顾性数据分析显示，两组在低温体外循环期间pHi均下降，但在手术结束时，C组的pHi显著更低（7.13±0.04 vs 7.31±0.001，P<0.001）。C组的体外循环时间和主动脉钳夹时间也更长，术中核心温度更低。持续自动张力计气体分析对于监测急性血流动力学和呼吸变化似乎更准确，未来可能会提高张力测定的预测价值。张力测定高度敏感，是一种针对危重症儿童的有趣且微创的监测方法。
