Ninke T, Eifer A, Dieterich H-J
Klinik für Anaesthesiologie, Klinikum Universität München, Campus Innenstadt, Lindwurmstraße 2a, 80377, München, Deutschland.
Anaesthesiologie. 2022 Oct;71(10):811-820. doi: 10.1007/s00101-022-01198-5. Epub 2022 Sep 2.
Immediately after birth the physiology of the cardiovascular system of the neonate undergoes some significant changes. The first breaths in life and the inflation of the lungs lead to a considerable drop in pulmonary arterial resistance. This results in the closure of the foramen ovale and ductus arteriosus; however, during the first weeks of life a sharp rise in pulmonary vascular resistance caused by hypoxia, hypercapnia and excessive positive pressure ventilation can lead to the reopening of the ductus arteriosus. This may result in subsequent strain of the left heart. In order to anticipate the reopening of the ductus arteriosus, it is recommended to measure the saturation of peripheral oxygen not only preductal (right hand), but also postductal (feet).An excessive volume therapy should be avoided as the neonatal myocardium is hallmarked by low cardiac compliance, reduced contractility and reduced ventricular filling.Until now there is still no uniform definition of hypotension in pediatric patients. Blood pressure values that are measured in awake children or are derived from the 50% age percentile values can thus only be used as approximate values. In all cases it is mandatory to recognize and consistently treat hypotension during pediatric anesthesia in order to prevent postoperative organ damage, particularly of the brain.The transcranial measurement of cerebral regional oxygen saturation (c‑rSO) by means of near-infrared spectroscopy (NIRS) provides valuable information about regional tissue oxygenation of the brain. This enables conclusions about the state of the multifactorial cerebral perfusion to be drawn. In this way monitoring of the hypoxia sensitive cerebral tissue can be accomplished and should be used in premature infants and neonates. When measuring a baseline in awake patients, a 20% drop of c‑rSO from this baseline should be challenged and treated if necessary.
新生儿出生后，其心血管系统的生理机能会立即发生一些显著变化。出生后的第一声啼哭以及肺部的扩张会导致肺动脉阻力大幅下降。这会致使卵圆孔和动脉导管关闭；然而，在出生后的头几周内，由缺氧、高碳酸血症和过度正压通气引起的肺血管阻力急剧上升，可能会导致动脉导管重新开放。这可能会导致随后左心负荷加重。为了预测动脉导管的重新开放，建议不仅要测量导管前（右手）的外周血氧饱和度，还要测量导管后（足部）的外周血氧饱和度。应避免过度的容量治疗，因为新生儿心肌的特点是心脏顺应性低、收缩力降低和心室充盈减少。到目前为止，儿科患者低血压仍没有统一的定义。因此，在清醒儿童中测量的血压值或从年龄百分位数50%得出的血压值只能用作近似值。在所有情况下，在小儿麻醉期间必须识别并持续治疗低血压，以防止术后器官损伤，尤其是脑损伤。通过近红外光谱（NIRS）进行脑区域氧饱和度（c-rSO）的经颅测量可提供有关脑区域组织氧合的有价值信息。这使得能够得出关于多因素脑灌注状态的结论。通过这种方式，可以实现对缺氧敏感脑组织的监测，并且该监测应在早产儿和新生儿中使用。在清醒患者中测量基线时，如果c-rSO从该基线下降20%，应予以关注并在必要时进行治疗。
