Kakuta Nami, Kawahito Shinji, Mita Naoji, Kambe Noriko, Kasai Asuka, Wakamatsu Narutomo, Katayama Toshiko, Soga Tomohiro, Tada Fumihiko, Kitaichi Takashi, Kitagawa Tetsuya, Kitahata Hiroshi
Department of Anesthesiology, Tokushima University Hospital.
J Med Invest. 2013;60(3-4):272-5. doi: 10.2152/jmi.60.272.
A PediaSat™ oximetry catheter (PediaSat: Edwards Lifesciences Co., Ltd., Irvine, CA, U. S. A.), which facilitates continuous measurement of central venous oxygen saturation (ScvO2), may be useful for surgery for pediatric congenital heart disease. We used PediaSat during a bidirectional Glenn shunt. The patient was a 13-month-old boy. Under a diagnosis of left single ventricle (pulmonary atresia, right ventricular hypoplasia, atrial septal defect) and residual left aortic arch/left superior vena cava, a modified right Blalock-Taussig shunt was performed. Cyanosis deteriorated, so a bidirectional Glenn shunt was scheduled. After anesthesia induction, a 4.5 Fr double-lumen (8 cm) PediaSat was inserted through the right internal jugular vein for continuous ScvO2 monitoring. Furthermore, the probe of a near-infrared, mixed blood oxygen saturation-measuring monitor was attached to the forehead for continuous monitoring of the regional brain tissue mixed blood oxygen saturation (rSO2) (INVOS™ 5100C, Covidien; Boulder, CO, U. S. A.). Blockage of the right pulmonary artery and right superior vena cava decreased the oxygen saturation, ScvO2, and rSO2, but increased the central venous pressure. Although changes in ScvO2 were parallel to those in rSO2, the former showed more marked changes. A combination of ScvO2 and rSO2 for monitoring during Glenn shunt may be safer.
一种便于连续测量中心静脉血氧饱和度（ScvO2）的小儿专用血氧饱和度导管（小儿专用血氧饱和度导管：爱德华兹生命科学有限公司，美国加利福尼亚州欧文市），可能对小儿先天性心脏病手术有用。我们在双向格林分流术中使用了小儿专用血氧饱和度导管。患者为一名13个月大的男孩。诊断为左单心室（肺动脉闭锁、右心室发育不全、房间隔缺损）及残留左主动脉弓/左上腔静脉，行改良右布莱洛克-陶西格分流术。发绀加重，因此计划行双向格林分流术。麻醉诱导后，经右颈内静脉插入一根4.5 Fr双腔（8 cm）小儿专用血氧饱和度导管，用于连续监测ScvO2。此外，将一台近红外混合血氧饱和度测量监测仪的探头贴在前额，用于连续监测局部脑组织混合血氧饱和度（rSO2）（INVOS™ 5100C，科惠医疗；美国科罗拉多州博尔德市）。右肺动脉和右上腔静脉阻断使血氧饱和度、ScvO2和rSO2降低，但中心静脉压升高。虽然ScvO2的变化与rSO2的变化平行，但前者变化更明显。在格林分流术中联合使用ScvO2和rSO2进行监测可能更安全。
