de Geeter B, Heitz A, Eisenmann B, Willard D, Kieny R
Arch Mal Coeur Vaiss. 1981 May;74(5):573-8.
Adaptation to extrauterine life is always precarious in the newborn with cyanotic cardiac malformations. Limited survival is possible in cases with obstructive lesions of the right heart providing ductal closure is delayed. This was monitored in 3 cyanotic neonates with ductal dependant cardiac malformations (tricuspid atresia, transposition of the great arteries with atresia or severe stenosis of the pulmonary valve) by continuous measurement of the cutaneous pO2. The value of cutaneous pO2 monitoring has already been established. It is a reliable indicator of arterial pO2 in the neonatal period. Its major advantage, apart from the possibility of continuous monitoring, is that it is non-invasive and may be performed at the bedside. Analysis of curves recorded over several hours or days showed the cyclical nature of cutaneous pO2, probably related to slow variations in ductal diameter equilibrating effective pulmonary flow, arterial pO2 and ductal constriction. Prolonged hyperoxygenation of these desaturated children does not usually improve their condition; progressive deterioration due to the constrictive effect of oxygen on the ductus may be observed. When a clear decrease in the amplitude of oscillation is recorded ductal closure is imminent and palliative surgery should be undertaken whenever possible.
对于患有青紫型心脏畸形的新生儿来说，适应宫外生活总是充满风险。对于右心梗阻性病变的患儿，如果动脉导管关闭延迟，就有可能延长生存期。通过连续测量皮肤氧分压，对3例患有动脉导管依赖性心脏畸形（三尖瓣闭锁、大动脉转位合并肺动脉瓣闭锁或严重狭窄）的青紫型新生儿进行了监测。皮肤氧分压监测的价值已经得到确立。它是新生儿期动脉血氧分压的可靠指标。其主要优点，除了能够进行连续监测外，还在于它是非侵入性的，并且可以在床边进行。对记录数小时或数天的曲线进行分析表明，皮肤氧分压具有周期性，这可能与动脉导管直径的缓慢变化有关，这种变化平衡了有效肺血流量、动脉血氧分压和动脉导管收缩。对这些低氧血症患儿进行长时间的高氧治疗通常并不能改善他们的病情；可能会观察到由于氧对动脉导管的收缩作用而导致的病情逐渐恶化。当记录到振荡幅度明显下降时，动脉导管即将关闭，应尽可能进行姑息性手术。
