Amigoni Angela, Mozzo Elena, Brugnaro Luca, Tiberio Ivo, Pittarello Demetrio, Stellin Giovanni, Bonato Raffaele
Department of Cardiovascular Surgery, University of Padua, Padua, Italy.
Interact Cardiovasc Thorac Surg. 2011 May;12(5):707-12. doi: 10.1510/icvts.2010.253328. Epub 2011 Feb 19.
In this study we monitored renal, hepatic and muscular oxygen saturations by near-infrared spectroscopy and we evaluated the correlation with variables that could affect tissue oxygenation in 16 paediatric patients during surgical heart procedure. We considered the following phases: 1) basal time (after induction of anaesthesia and before median sternotomy), 2) before starting cardiopulmonary bypass, 3) 15 min after starting it, 4) at half time, 5) 15 min before the end, 6) at the end, 7) 15 min after the end, and 8) 10 min before paediatric intensive care unit admission. Heart rate, mean arterial pressure, peripheral oxygen saturation, serum lactate, haemoglobin, blood gas analysis, and rectal temperature were registered. We found a decrease of all monitored regional saturations (rSO(2)) (cerebral P = 0.006, hepatic P = 0.005) before starting the bypass. After this time, cerebral saturation gradually increased without reaching the basal value; renal and liver saturations increased after starting bypass; muscular rSO(2) increased in the second half (P = 0.005). A statistically significative inverse correlation between cerebral rSO(2) and pH was observed. In conclusion, during paediatric heart surgery a vulnerable period was identified. We underline the necessity to monitor this phase.
在本研究中，我们通过近红外光谱法监测了16例小儿心脏手术患者的肾脏、肝脏和肌肉氧饱和度，并评估了其与可能影响组织氧合的变量之间的相关性。我们考虑了以下阶段：1）基础时间（麻醉诱导后和正中胸骨切开术前），2）开始体外循环前，3）开始体外循环15分钟后，4）中途，5）结束前15分钟，6）结束时，7）结束后15分钟，以及8）进入儿科重症监护病房前10分钟。记录心率、平均动脉压、外周血氧饱和度、血清乳酸、血红蛋白、血气分析和直肠温度。我们发现，在开始体外循环前，所有监测区域的饱和度（rSO₂）均下降（脑饱和度P = 0.006，肝饱和度P = 0.005）。此后，脑饱和度逐渐升高，但未达到基础值；肾脏和肝脏饱和度在开始体外循环后升高；肌肉rSO₂在第二阶段升高（P = 0.005）。观察到脑rSO₂与pH之间存在统计学意义的负相关。总之，在小儿心脏手术期间确定了一个脆弱期。我们强调监测这一阶段的必要性。
