Department of Cardiovascular Surgery, Chiba Children's Hospital, Chiba, Japan.
Ann Thorac Surg. 2010 Jan;89(1):168-73. doi: 10.1016/j.athoracsur.2009.09.032.
The physiologic goal of management after a Norwood procedure is to optimize systemic oxygen delivery, as indicated by oxygen excess factor (OEF). Factors were examined that might affect systemic oxygen delivery after the Norwood procedure with right ventricle-to-pulmonary artery (RV-PA) conduit as the pulmonary blood supply.
Hemodynamic data of 9 patients (mean age, 25.0 days; mean weight, 2.9 kg) who underwent a modified Norwood operation for hypoplastic left heart syndrome (HLHS) between April 2003 and April 2008 were retrospectively analyzed. Variables were obtained by manometry and oximetry from indwelling catheters in the systemic artery, pulmonary artery, and superior vena cava at 3- to 6-hour intervals for 72 hours postoperatively. Systemic (Qs) and pulmonary (Qp) blood flow, systemic vascular resistance (SVR), and pulmonary vascular resistance (PVR) were calculated.
A significant increase in SVR and decrease in PVR occurred during the first 6 hours, which might be inductive to sudden cardiovascular collapse. SVR and PVR significantly decreased over time through 24 hours, followed by a lower steady increase. OEF was closely correlated with SVR (p < 0.0001). No correlation of OEF with PVR (p = 0.65) was noted among the assumed variables. Mixed venous oxygen saturation (SVO(2)) and OEF were strongly correlated. Pulmonary arterial pressure and OEF were weakly correlated.
Postoperative management strategies to maintain a low SVR, rather than manipulating PVR, appear to be rational to achieve adequate oxygen delivery after a Norwood procedure with Sano modification. The SVO(2) provides reliable prediction of OEF during postoperative hemodynamic recovery.
在 Norwood 手术后，管理的生理目标是优化全身氧输送，这可以通过氧过剩因子（OEF）来指示。本研究检查了可能影响使用右心室至肺动脉（RV-PA）导管作为肺血供的 Norwood 手术后全身氧输送的因素。
回顾性分析了 2003 年 4 月至 2008 年 4 月期间接受改良 Norwood 手术治疗左心发育不全综合征（HLHS）的 9 例患者（平均年龄 25.0 天，平均体重 2.9kg）的血流动力学数据。术后 3 至 6 小时间隔通过留置在体动脉、肺动脉和上腔静脉中的导管进行测压和血氧饱和度测定，共 72 小时。计算全身（Qs）和肺（Qp）血流量、全身血管阻力（SVR）和肺血管阻力（PVR）。
SVR 在最初 6 小时内显著增加，PVR 显著降低，可能导致心血管突然崩溃。SVR 和 PVR 在 24 小时内持续下降，随后缓慢稳定增加。OEF 与 SVR 密切相关（p < 0.0001）。OEF 与 PVR（p = 0.65）之间无相关性。假设变量中未发现混合静脉血氧饱和度（SVO2）与 OEF 之间存在相关性。
维持低 SVR 的术后管理策略，而不是操纵 PVR，对于使用 Sano 改良的 Norwood 手术后实现足够的氧输送似乎是合理的。在术后血流动力学恢复期间，SVO2 可可靠地预测 OEF。
