Weiss B M, Atanassoff P G, Jenni R, Walder B, Wight E
Department of Anesthesiology, University Hospital, Zurich, Switzerland.
Yale J Biol Med. 1998 Jan-Feb;71(1):15-21.
A 21-year-old patient with pulmonary atresia and ventricular septal defect (PA-VSD) was admitted to the hospital for tubal ligation. Invasive arterial and central venous (CVP) pressure, pulse oximetric oxygen saturation (SpO2), and (from the tip of oximetric central venous catheter) central venous oxygen saturation (ScvO2) and oxygen extraction rate (ExO2) were continuously monitored. Heart rate (range: 68-75 beat/min), mean arterial pressure (80-90 mmHg), CVP (7-10 mmHg), SpO2 (79-90 percent), ScvO2 (57-70 percent), and ExO2 (21-30 percent) remained stable during epidural anesthesia and transvaginal sterilization. Following an overnight stay (peak SpO2 92 percent; peak ScvO2 71 percent; through ExO2 21 percent), the oxygen data returned to baseline on awakening (SpO2 < 80 percent, ScvO2 < 55 percent, ExO2 > 35 percent), and the patient was discharged. In PA-VSD, a single-outlet double-ventricle anomaly, CVP reflects the preload of systemic ventricle. As the mixed venous oxygen saturation cannot be defined, ScvO2 is the best available indicator of the whole body oxygen consumption. Continuous monitoring of CVP, ScvO2 and ExO2 in the superior vena cava may provide more insight into the response to anesthesia and surgery in patients with PA-VSD.
一名患有肺动脉闭锁合并室间隔缺损（PA-VSD）的21岁患者因输卵管结扎入院。持续监测有创动脉压和中心静脉压（CVP）、脉搏血氧饱和度（SpO2）以及（通过血氧测定中心静脉导管尖端测得的）中心静脉血氧饱和度（ScvO2）和氧摄取率（ExO2）。在硬膜外麻醉和经阴道绝育手术期间，心率（范围：68 - 75次/分钟）、平均动脉压（80 - 90 mmHg）、CVP（7 - 10 mmHg）、SpO2（79 - 90%）、ScvO2（57 - 70%）和ExO2（21 - 30%）保持稳定。过夜观察后（SpO2峰值92%；ScvO2峰值71%；ExO2峰值21%），患者醒来时氧数据恢复至基线水平（SpO2 < 80%，ScvO2 < 55%，ExO2 > 35%），随后出院。在PA-VSD（一种单出口双心室畸形）中，CVP反映体循环心室的前负荷。由于无法定义混合静脉血氧饱和度，ScvO2是全身氧消耗的最佳可用指标。对上腔静脉的CVP、ScvO2和ExO2进行连续监测，可能有助于更深入了解PA-VSD患者对麻醉和手术的反应。
