Wong Judith Ju-Ming, Chen Ching Kit, Moorakonda Rajesh Babu, Wijeweera Olivia, Tan Tracy Yi Shuen, Nakao Masakazu, Allen John Carson, Loh Tsee Foong, Lee Jan Hau
Children's Intensive Care Unit, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore.
Duke-NUS Medical School, Singapore, Singapore.
Front Pediatr. 2018 Apr 13;6:97. doi: 10.3389/fped.2018.00097. eCollection 2018.
Since oxygen saturation from pulse oximetry (SpO) and partial pressure of arterial oxygen (PaO) are observed to improve immediately after surgical correction of cyanotic congenital heart disease (CHD), we postulate that cerebral (CrO) and somatic (SrO) oximetry also improves immediately post-correction. We aim to prospectively examine CrO and SrO, before, during, and after surgical correction as well as on hospital discharge in children with cyanotic CHD to determine if and when these variables increase.
This is a prospective observational trial. Eligibility criteria included children below 18 years of age with cyanotic CHD who required any cardiac surgical procedure. CrO and SrO measurements were summarized at six time-points for comparison: (1) pre-cardiopulmonary bypass (CPB); (2) during CPB; (3) post-CPB; (4) Day 1 in the pediatric intensive care unit (PICU); (5) Day 2 PICU; and (6) discharge. Categorical and continuous variables are presented as counts (percentages) and median (interquartile range), respectively.
Twenty-one patients were analyzed. 15 (71.4%) and 6 (28.6%) patients underwent corrective and palliative surgeries, respectively. In the corrective surgery group, SpO increased immediately post-CPB compared to pre-CPB [99 (98, 100) vs. 86% (79, 90); < 0.001] and remained in the normal range through to hospital discharge. Post-CPB CrO did not change from pre-CPB [72.8 (58.8, 79.0) vs. 72.1% (63.0, 78.3); = 0.761] and even decreased on hospital discharge [60.5 (53.6, 62.9) vs. 72.1% (63.0, 78.3); = 0.005]. Post-CPB SrO increased compared to pre-CPB [87.3 (77.2, 89.5) vs. 72.7% (65.6, 77.3); = 0.001] but progressively decreased during PICU stay to a value lower than baseline at hospital discharge [66.9 (57.3, 76.9) vs. 72.7% (65.6, 77.3); = 0.048].
CrO and SrO did not increase after corrective surgery of cyanotic CHD even up to hospital discharge. Future larger studies are required to validate these findings. (This study is registered with ClinicalTrials.gov ID: NCT02417259.).
由于观察到紫绀型先天性心脏病（CHD）手术矫正后，脉搏血氧饱和度（SpO）和动脉血氧分压（PaO）立即改善，我们推测脑血氧饱和度（CrO）和体血氧饱和度（SrO）在矫正后也会立即改善。我们旨在前瞻性地检查紫绀型CHD患儿手术矫正前、手术过程中、手术后以及出院时的CrO和SrO，以确定这些变量是否以及何时增加。
这是一项前瞻性观察性试验。纳入标准包括年龄在18岁以下需要进行任何心脏手术的紫绀型CHD患儿。CrO和SrO测量值在六个时间点进行汇总比较：（1）体外循环（CPB）前；（2）CPB期间；（3）CPB后；（4）儿科重症监护病房（PICU）第1天；（5）PICU第2天；（6）出院时。分类变量和连续变量分别以计数（百分比）和中位数（四分位间距）表示。
分析了21例患者。分别有15例（71.4%）和6例（28.6%）患者接受了矫正手术和姑息手术。在矫正手术组中，与CPB前相比，CPB后SpO立即升高[99（98，100）对86%（79，90）；<0.001]，直至出院一直保持在正常范围内。CPB后CrO与CPB前相比没有变化[72.8（58.8，79.0）对72.1%（63.0，78.3）；=0.761]，甚至在出院时下降[60.5（53.6，62.9）对72.1%（63.0，78.3）；=0.005]。与CPB前相比，CPB后SrO升高[87.3（77.2，89.5）对72.7%（65.6，77.3）；=0.001]，但在PICU住院期间逐渐下降，至出院时低于基线值[66.9（57.3，76.9）对72.7%（65.6，77.3）；=0.048]。
紫绀型CHD矫正手术后，即使到出院时，CrO和SrO也没有升高。需要未来更大规模的研究来验证这些发现。（本研究已在ClinicalTrials.gov注册，ID：NCT02417259。）
