Miura Shinya, Ookoshi Youichi, Momoki Kodai, Hoshino Kenji, Ueta Ikuya
Department of Pediatric Intensive Care, Saitama Children's Medical Center, 1-2, Shintoshin, Chuou-ku, Saitama, 330-8777, Japan.
Department of Pediatric Cardiology, Saitama Children's Medical Center, Saitama, Japan.
Pediatr Cardiol. 2019 Jan;40(1):216-218. doi: 10.1007/s00246-018-1997-2. Epub 2018 Oct 10.
In cases involving single ventricles, predicting streaming characteristics is difficult. Unfavorable streaming can cause decreased oxygen saturation. Judging whether desaturation results from decreased pulmonary flow or unfavorable streaming is critical. A 20-day-old infant with a single left ventricle underwent ductus arteriosus ligation and pulmonary artery banding to control high pulmonary flow. Severe desaturation presented postoperatively, which worsened to 68% despite pure-oxygen ventilation. A bedside contrast echocardiogram helped determine whether unfavorable streaming caused desaturation. It revealed systemic venous streaming predominantly directed to the aorta. Emergent balloon atrial septostomy facilitated mixing at the atrial level. Oxygen saturation promptly increased to 85%.
在涉及单心室的病例中，预测血流特征很困难。不良血流会导致氧饱和度降低。判断饱和度降低是由于肺血流量减少还是不良血流所致至关重要。一名20天大的单左心室婴儿接受了动脉导管结扎和肺动脉束带术以控制高肺血流量。术后出现严重的饱和度降低，尽管进行了纯氧通气，饱和度仍降至68%。床边对比超声心动图有助于确定不良血流是否导致了饱和度降低。结果显示体静脉血流主要导向主动脉。紧急球囊房间隔造口术促进了心房水平的血液混合。氧饱和度迅速升至85%。
