Department of Anesthesiology, Hokkaido University Hospital, N14 W5, Sapporo, 0608648, Japan.
Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Sapporo, 0608638, Japan.
Pediatr Cardiol. 2021 Feb;42(2):370-378. doi: 10.1007/s00246-020-02492-y. Epub 2020 Nov 17.
Recently, tissue oxygenation in pediatric heart surgery is measured by using near-infrared spectroscopy. Monitoring of cerebral oxygen saturation (ScO) is most common but that of somatic tissue oxygen saturation (SrO) is also gradually becoming widespread. However, the value of their monitoring is not well established. One of the reasons for this may be that the physiological factors affecting ScO and SrO have not been sufficiently clarified. Accordingly, we prospectively observed the changes in ScO and SrO simultaneously throughout cardiac surgery with cardiopulmonary bypass (CPB) in children weighing under 10 kg and evaluated their relationships with physiological parameters by using the random-effects model. ScO and SrO were measured with an INVOS 5100C (Somanetics, Troy, MI, USA). The random-effects analysis was applied for ScO and SrO, as dependent variables, and seven physiological parameters (mean blood pressure, central venous pressure, rectal temperature, SaO, hematocrit PaCO, and pH) were entered as independent covariates. The analysis was performed during the pre-CPB, CPB, and post-CPB periods. Next, the same analysis was performed by dividing the patients into univentricular and biventricular physiological types. Forty-one children were evaluated. Through the whole surgical period, ScO correlated strongly with mean blood pressure regardless of the physiological type. On the other hand, the contribution of mean blood pressure to SrO was weak and various other parameters were related to SrO changes. Thus, the physiological parameters affecting ScO and SrO were rather different. Accordingly, the significance of monitoring of cerebral and somatic tissue oxygen saturation in pediatric cardiac surgery should be further evaluated.
最近，儿科心脏手术中的组织氧合通过近红外光谱进行测量。脑氧饱和度（ScO）的监测最为常见，但躯体组织氧饱和度（SrO）的监测也逐渐普及。然而，其监测的价值尚未得到充分确立。造成这种情况的原因之一可能是影响 ScO 和 SrO 的生理因素尚未得到充分阐明。因此，我们前瞻性地观察了体重小于 10kg 的儿童在体外循环（CPB）心脏手术期间 ScO 和 SrO 的同时变化，并通过随机效应模型评估了它们与生理参数的关系。ScO 和 SrO 用 INVOS 5100C（Somanetics，Troy，MI，USA）进行测量。随机效应分析应用于 ScO 和 SrO 作为因变量，将七个生理参数（平均血压、中心静脉压、直肠温度、SaO、红细胞压积、PaCO 和 pH）作为独立协变量。分析在 CPB 前、CPB 中和 CPB 后进行。接下来，将相同的分析应用于将患者分为单心室和双心室生理类型。共评估了 41 名儿童。在整个手术期间，无论生理类型如何，ScO 与平均血压密切相关。另一方面，平均血压对 SrO 的贡献较弱，其他各种参数与 SrO 变化有关。因此，影响 ScO 和 SrO 的生理参数有很大差异。因此，应进一步评估监测儿科心脏手术中脑和躯体组织氧饱和度的意义。
