King Michael R, Anderson T Anthony, Sui Jinghu, He Guoluo, Poon Kwun Yee T, Coté Charles J
Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
J Clin Anesth. 2016 Aug;32:181-8. doi: 10.1016/j.jclinane.2016.02.026. Epub 2016 Apr 22.
To assess the effects of desaturation on stroke index (SI), cardiac index (CI), and heart rate (HR) using the ICON continuous noninvasive cardiac output monitor in children undergoing general anesthesia.
Retrospective analysis of a prospectively collected data set.
Pediatric operating rooms in a tertiary academic medical center.
Children younger than 20 years who experienced desaturation while undergoing general anesthesia.
All records were retrospectively searched for desaturation events defined as a recorded Spo2 ≤ 90%. We compared the data from the prior 4 minutes (baseline) with mild, moderate, and severe levels of desaturation.
The relationship between Spo2 and percent change in SI, CI, and HR from baseline was assessed using a generalized linear model with repeated measures and the least-squares method.
Data from 446 patients were reviewed; 38 events were eligible for analysis after exclusions. There were significant decreases in SI at all saturation ranges below 95%: -6.5% (P < .001) for 85%-95%, -8.9% (P = .002) for 71%-84%, and -11% (P < .001) for ≤70%. Based on the result from the regression, Spo2 was associated with change in SI with borderline significance (P = .053) but not that of HR and CI. There was a strong relationship to desaturation events with young age (P < .001), particularly infants younger than 6 months.
Events associated with desaturation in children under general anesthesia were significantly associated with decreased SI with a greater effect with lower saturation nadirs. It is unclear if other concurrent events could have also contributed to adverse hemodynamic responses during desaturation. In most children, a compensatory increase in HR generally offsets concurrent decreases in CI. It would appear that bradycardia is a late manifestation of hypoxemia.
使用ICON连续无创心输出量监测仪，评估全身麻醉下儿童血氧饱和度降低对每搏输出指数（SI）、心脏指数（CI）和心率（HR）的影响。
对前瞻性收集的数据集进行回顾性分析。
一所三级学术医疗中心的儿科手术室。
20岁以下全身麻醉期间出现血氧饱和度降低的儿童。
回顾所有记录，寻找定义为记录的血氧饱和度（Spo2）≤90%的血氧饱和度降低事件。我们将前4分钟（基线）的数据与轻度、中度和重度血氧饱和度降低水平进行了比较。
使用具有重复测量的广义线性模型和最小二乘法评估Spo2与SI、CI和HR相对于基线的变化百分比之间的关系。
回顾了446例患者的数据；排除后有38个事件符合分析条件。在所有低于95%的饱和度范围内，SI均显著降低：85%-95%时降低-6.5%（P<.001），71%-84%时降低-8.9%（P=.002），≤70%时降低-11%（P<.001）。根据回归结果，Spo2与SI的变化具有临界显著性（P=.053），但与HR和CI的变化无关。年龄小与血氧饱和度降低事件有很强的相关性（P<.001），尤其是6个月以下的婴儿。
全身麻醉下儿童与血氧饱和度降低相关的事件与SI降低显著相关，饱和度最低点越低影响越大。尚不清楚其他并发事件是否也可能导致血氧饱和度降低期间的不良血流动力学反应。在大多数儿童中，HR的代偿性增加通常会抵消CI同时出现的降低。心动过缓似乎是低氧血症的晚期表现。
