在诺伍德手术后，通过连续测量耗氧量得出的血流动力学和氧输送情况。
Profiles of hemodynamics and oxygen transport derived by using continuous measured oxygen consumption after the Norwood procedure.
作者信息
Li Jia, Zhang Gencheng, McCrindle Brian W, Holtby Helen, Humpl Tilman, Cai Sally, Caldarone Christopher A, Redington Andrew N, Van Arsdell Glen S
机构信息
Cardiac Program, the Hospital for Sick Children, Toronto, Ontario, Canada.
出版信息
J Thorac Cardiovasc Surg. 2007 Feb;133(2):441-8. doi: 10.1016/j.jtcvs.2006.09.033.
OBJECTIVES
The lack of accurate measurement of hemodynamics and oxygen transport has limited our understanding of Norwood physiology and postoperative management. We used measured oxygen consumption to characterize hemodynamics and oxygen transport after the classic Norwood procedure.
METHODS
Fourteen neonates had continuous respiratory mass spectrometry to measure oxygen consumption (VO2). Arterial, superior vena caval, and pulmonary venous saturations were measured at 2- to 4-hour intervals for 72 hours postoperatively. Systemic (Qs) and pulmonary (Qp) blood flows, systemic vascular resistance (SVR) and pulmonary vascular resistance inclusive of the Blalock-Taussig shunt (BT-PVR), systemic oxygen delivery (DO2), and the oxygen extraction ratio (ERO2) were calculated.
RESULTS
Qs and DO2 were low during the first 12 hours (1.8 +/- 0.6 L x min(-1) x m(-2) and 281 +/- 86 mL x min(-1) x m(-2) at the 12th hour, respectively) and increased over the study period (P < .05 for both). VO2 decreased markedly during the first 24 hours (101 +/- 26 to 86 +/- 16 mL x min(-1) x m(-2), P < .0001). Consequently, ERO2 decreased significantly over the study, most rapidly during the first 24 hours (0.44 +/- 0.11 to 0.28 +/- 0.09, P < .0001). There was a close correlation of DO2 to SVR and to Qs (P < .0001 for both). There was no correlation of DO2 to BT-PVR (P = .14) or to Qp (P = .67). DO2 was closely correlated with hemoglobin value (P < .0001), weakly correlated with PaO2 (P = .0002), and not correlated with arterial oxygen saturation (P = .32).
CONCLUSIONS
There is wide variability of hemodynamics and oxygen transport after the Norwood procedure. The decrease in VO2 during the first 24 hours is the main contributor to improving the balance of oxygen transport. DO2 is most closely correlated to SVR and hemoglobin and weakly correlated to PaO2. It is not correlated to Qp. Postoperative management strategies to decrease VO2 and maintain a high hemoglobin level and a low SVR appear to be rational.
目的
由于缺乏对血流动力学和氧输送的准确测量，我们对诺伍德手术的生理学及术后管理的理解受到了限制。我们使用测量的氧耗量来描述经典诺伍德手术后的血流动力学和氧输送情况。
方法
14例新生儿接受持续呼吸质谱分析以测量氧耗量（VO₂）。术后72小时内，每隔2至4小时测量动脉、上腔静脉和肺静脉血氧饱和度。计算体循环（Qs）和肺循环（Qp）血流量、体循环血管阻力（SVR）以及包括布莱洛克 - 陶西格分流术（BT - PVR）的肺循环血管阻力、体循环氧输送（DO₂）和氧摄取率（ERO₂）。
结果
在最初12小时内，Qs和DO₂较低（第12小时时分别为1.8±0.6L·min⁻¹·m⁻²和281±86mL·min⁻¹·m⁻²），且在研究期间有所增加（两者P均<.05）。VO₂在最初24小时内显著下降（从101±26降至86±16mL·min⁻¹·m⁻²，P<.0001）。因此，ERO₂在研究期间显著下降，在最初24小时内下降最为迅速（从0.44±0.11降至0.28±0.09，P<.0001）。DO₂与SVR和Qs密切相关（两者P均<.0001）。DO₂与BT - PVR（P = 0.14）或Qp（P = 0.67）无相关性。DO₂与血红蛋白值密切相关（P<.0001），与动脉血氧分压（PaO₂）弱相关（P = 0.0002），与动脉血氧饱和度无相关性（P = 0.32）。
结论
诺伍德手术后血流动力学和氧输送存在很大差异。最初24小时内VO₂的下降是改善氧输送平衡的主要因素。DO₂与SVR和血红蛋白相关性最强，与PaO₂弱相关，与Qp无相关性。降低VO₂并维持高血红蛋白水平和低SVR的术后管理策略似乎是合理的。
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