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- 2017
先天性心脏病患儿术前脑组织氧合的观察
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Abstract:
目的 ·观察心内不同分流方向对先天性心脏病患儿术前局部脑组织氧合的影响。 方法 ·选择年龄在4～24个月择期手术的室间隔缺损（VSD组）、法洛四联症（ TOF组）及腹股沟斜疝（对照组）患儿，每组各20例。采用NIRS监测患儿前额两侧局部脑组织氧合指数（TOI）。测量并记录患儿血氧饱和度（SpO2）、无创血压（NIBP）、心率（HR）。比较3组患儿TOI及局部脑组织氧摄取率（FTOE），分析患儿TOI的影响因素。 结果 · VSD组患儿术前两侧TOI与对照组患儿比较，差异无统计学意义（P>0.05）。TOF组患儿两侧TOI均明显低于其余2组(均P=0.000)，FTOE较VSD组患儿增高（P=0.005）。多元线性回归分析显示先天性心脏病患儿TOI只与SpO2相关（r =0.560，P=0.000）。 结论 ·不同的分流方向可通过影响先天性心脏病患儿的体循环氧供而影响脑组织氧合。右向左分流先天性心脏病患儿，SpO2降低导致TOI降低，FTOE继发性升高。
： Objective · To explore the effect of intracardiac shunts direction on preoperative cerebral tissue oxygenation in children with congenital heart disease. Methods · Sixty children aged from 4 to 24 months diagnosed with ventricular septal defect (VSD group), tetralogy of Fallot (TOF group) and indirect inguinal hernia (control group) undergoing elective surgeries were recruited, with 20 cases in each group. The NIRS cerebral oximeter was used to monitor TOI of patients. Two sensors were placed on the subject’s forehead bilaterally for continuous monitoring of cerebral oximetry. Pulse oxygen saturation (SpO2), noninvasive blood pressure, heart rate were also measured and recorded. TOI and fractional tissue oxygen extraction (FTOE) were compared among the three groups and multiple linear regression analysis was used to evaluate the relationship between TOI and these parameters. Results · There was no significant difference in TOI between VSD group and control group (P>0.05). Both sides of TOI in TOF group were significantly lower than those in other two groups (P=0.000) and FTOE in TOF group were significantly higher than those in VSD group (P=0.005). Multiple linear regression analysis showed that only SpO2 was related to TOI in children with congenital heart disease (r=0.560, P=0.000). Conclusion · Different intracardiac shunts direction can affect cerebral tissue oxygenation through affecting systemic oxygen supply. Children with right-to-left shunt physiology have lower TOI and higher FTOE due to low systemic oxygenation
