Day R W, Tani L Y, Minich L L, Shaddy R E, Orsmond G S, Hawkins J A, McGough E C
University of Utah, Salt Lake City 84113, USA.
J Heart Lung Transplant. 1995 Jul-Aug;14(4):718-25.
An unfavorable balance in systemic and pulmonary perfusion may occur in neonates with ductal-dependent systemic perfusion while being treated with prostaglandin E1 before surgical palliation or transplantation. At our institution, we adjust the fraction of inspired oxygen, with supplemental nitrogen if needed, to control pulmonary vascular tone and maintain systemic oxygen saturations near 75%.
We performed a noninvasive Doppler ultrasound study in 10 patients to determine whether velocity time integrals in the descending aorta and middle cerebral arteries and the peak velocity at the foramen ovale were acutely altered by changes in the fraction of inspired oxygen. Measurements were performed after 10- to 15-minute intervals of breathing 14% to 19%, 21%, and 35% oxygen.
Antegrade descending aortic velocity time integrals did not change significantly when these patients breathed different amounts of oxygen; however, the retrograde velocity time integral in the descending aorta and the peak velocity of left-to-right shunt at the foramen ovale increased with increasing amounts of inspired oxygen. The ratio of antegrade to retrograde velocity time integrals in the descending aorta was greater with supplemental nitrogen than with supplemental oxygen. Middle cerebral arterial velocity time integrals were not significantly greater with supplemental nitrogen than with supplemental oxygen (p = 0.061).
Systemic and interatrial Doppler velocities are acutely influenced by the fraction of inspired oxygen in neonates with ductal-dependent systemic perfusion.
在接受手术姑息治疗或移植前使用前列腺素E1治疗的依赖动脉导管进行体循环灌注的新生儿中，可能会出现体循环和肺循环灌注失衡。在我们机构，我们会调整吸入氧分数，必要时补充氮气，以控制肺血管张力并将体循环血氧饱和度维持在75%左右。
我们对10例患者进行了无创多普勒超声研究，以确定吸入氧分数的变化是否会急性改变降主动脉和大脑中动脉的速度时间积分以及卵圆孔处的峰值速度。在呼吸14%至19%、21%和35%氧气10至15分钟后进行测量。
当这些患者呼吸不同量的氧气时，降主动脉前向速度时间积分没有显著变化；然而，降主动脉逆向速度时间积分和卵圆孔处从左向右分流的峰值速度随着吸入氧量的增加而增加。补充氮气时降主动脉前向与逆向速度时间积分的比值大于补充氧气时。补充氮气时大脑中动脉速度时间积分与补充氧气时相比没有显著增加（p = 0.061）。
在依赖动脉导管进行体循环灌注的新生儿中，吸入氧分数会对体循环和心房间多普勒速度产生急性影响。
