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[小儿心血管手术中脑氧饱和度的影响因素]

[Influential factors of cerebral oxygen saturation in 
pediatric cardiovascular surgery].

作者信息

Li Qian, Zhu Mao'en, Zhang Yanrong, Dai Sisi, Zhang Junjie, Guo Qulian, Wang E

机构信息

Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha 410008, China.

出版信息

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2018 Mar 28;43(3):287-292. doi: 10.11817/j.issn.1672-7347.2018.03.009.

Abstract

To determine the intervention measures for the decrease of cerebral tissue oxygen saturation during anesthesia for the congenital heart disease in children.
 Methods: Twenty-eight children with cardiac surgery were enrolled. Anesthesia was deepened with propofol (3 mg/kg) intravenous injection. The data of cerebral tissue oxygen saturation(SctO2), mean arterial pressure (MAP), HR, bispectral index (BIS), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), hemoglobin (Hb) and middle cerebral artery (MCA) mean flow velocity (Vm) at different points were collected after intravenous injection of propofol at 3 mg/kg. The changes of SctO2 and the influential factors were analyzed.
 Results: SctO2 decreased by 4.99% after deepen anesthesia, with 95% CI 4.33% to 5.65% (P>0.05). There was no significant differince in MAP, PaO2, PaCO2, and Hb between the time points after deepen anesthesia and the baseline (P>0.05). MCA Vm decreased obviously after deepen anesthesia for 1, 5, 10 min (P<0.05). The decrease in MAP, HR, PaCO2 and MCA Vm is positively correlated with the decrease in SctO2.
 Conclusion: The decrease of MAP, HR, PaCO2, and MCA Vm is the risk factor for SctO2. To avoid the decrease, it needs to maintain the stability of SctO2 and prevent neurological complications.

摘要

确定小儿先天性心脏病麻醉期间脑组织氧饱和度降低的干预措施。方法:纳入28例心脏手术患儿。静脉注射丙泊酚(3mg/kg)加深麻醉。静脉注射3mg/kg丙泊酚后,收集不同时间点的脑组织氧饱和度(SctO2)、平均动脉压(MAP)、心率(HR)、脑电双频指数(BIS)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、血红蛋白(Hb)及大脑中动脉(MCA)平均血流速度(Vm)数据。分析SctO2的变化及其影响因素。结果:加深麻醉后SctO2下降4.99%,95%CI为4.33%至5.65%(P>0.05)。加深麻醉后各时间点与基线相比,MAP、PaO2、PaCO2及Hb差异均无统计学意义(P>0.05)。加深麻醉后1、5、10min时MCA Vm明显下降(P<0.05)。MAP、HR、PaCO2及MCA Vm的下降与SctO2的下降呈正相关。结论:MAP、HR、PaCO2及MCA Vm的下降是SctO2降低的危险因素。为避免其降低,需维持SctO2稳定,预防神经并发症。

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