婴幼儿先天性心脏病术后监测中心静脉血氧饱和度的意义
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摘要
目的研究中心静脉血氧饱和度(ScvO_2)监测对婴幼儿先天性心脏病术后病情变化的预警价值。方法采用便利抽样法选取2014年10月—2017年10月在本院诊治的先天性心脏病患儿120例为研究对象。对所有患儿资料进行回顾性分析,根据患儿结局将所有入选者分为存活组106例和死亡组14例。监测患儿的中心静脉血氧饱和度,分析其变化趋势与患儿结局的关系。结果存活组患儿ScvO_2最高值、最低值及均值依次为(73. 04±5. 22)%、(55. 12±5. 76)%、(63. 42±5. 36)%,死亡组患儿依次为(57. 79±7. 87)%、(40. 07±8. 31)%、(47. 29±6. 76)%,差异有统计学意义(P <0. 01)。ScvO_2均值≤45%的患儿中病死率为57. 14%,ScvO_2均值45%<～65%的患儿中病死率为11. 63%,ScvO_2均值> 65%的患儿中病死率为1. 59%,不同ScvO_2均值患儿的临床结局差异有统计学意义(χ~2=34. 310,P <0. 01)。结论动态监测ScvO_2可对婴幼儿先天性心脏病术后的病情起到预警作用,应密切监测患儿的ScvO_2变化趋势,并进行干预治疗,评估患儿预后。
Objective To investigate the early warning value of central venous oxygen saturation( ScvO_2) monitoring on state of illness in infants and young children after congenital heart surgery. Methods Totally 120 infants and young children who received surgical treatment for congenital heart disease were collected by the convenience sampling method. The clinical data of 120 cases were retrospectively analyzed,and children were divided into survival group( n = 106)and death group( n = 14) according to the treatment outcome. The ScvO_2 was monitored and its relationship with treatment outcome was analyzed. Results The maximum,minimum and average value of ScvO_2 was( 73. 04 ± 5. 22) %,( 55. 12 ± 5. 76) % and( 63. 42 ± 5. 36) % in the survival group respectively,and was( 57. 79 ± 7. 87) %,( 40. 07 ± 8. 31) % and( 47. 29 ± 6. 76) %in the death group respectively,with significant differences( P < 0. 01). The case-fatality rate was57. 14% in children with averaged ScvO_2 less than 45%,11. 63% in children with averaged ScvO_2 between 45% and 65%,1. 59% in those with averaged ScvO_2 higher than 65%,with a significant difference( χ~2 = 34. 310,P < 0. 01). Conclusion The dynamic monitoring on ScvO_2 shows an early warning value on state of illness in infants and young children after congenital heart surgery. Evaluation and targeted interventions should be carried timely according to the variation trend of ScvO_2.
Objective To investigate the early warning value of central venous oxygen saturation( ScvO_2) monitoring on state of illness in infants and young children after congenital heart surgery. Methods Totally 120 infants and young children who received surgical treatment for congenital heart disease were collected by the convenience sampling method. The clinical data of 120 cases were retrospectively analyzed,and children were divided into survival group( n = 106)and death group( n = 14) according to the treatment outcome. The ScvO_2 was monitored and its relationship with treatment outcome was analyzed. Results The maximum,minimum and average value of ScvO_2 was( 73. 04 ± 5. 22) %,( 55. 12 ± 5. 76) % and( 63. 42 ± 5. 36) % in the survival group respectively,and was( 57. 79 ± 7. 87) %,( 40. 07 ± 8. 31) % and( 47. 29 ± 6. 76) %in the death group respectively,with significant differences( P < 0. 01). The case-fatality rate was57. 14% in children with averaged ScvO_2 less than 45%,11. 63% in children with averaged ScvO_2 between 45% and 65%,1. 59% in those with averaged ScvO_2 higher than 65%,with a significant difference( χ~2 = 34. 310,P < 0. 01). Conclusion The dynamic monitoring on ScvO_2 shows an early warning value on state of illness in infants and young children after congenital heart surgery. Evaluation and targeted interventions should be carried timely according to the variation trend of ScvO_2.
引文
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[6]王峰峰.中心静脉血氧饱和度监测在婴幼儿先心病术后的应用研究[D].郑州:郑州大学,2012.
[7]汪曾炜,刘维永,张宝仁.手术学全集心血管外科手术学[M].2版.北京:人民军医出版社,2005.
[8]张青,谢婉花,邓丽珊,等.156例复杂性先天性心脏病患儿超声检查的镇静护理[J].全科护理,2016,14(10):1034-1035.
[9]李建斌,陈欣欣,崔虎军,等.73例新生儿先天性心脏病的手术时机选择分析[J].中华小儿外科杂志,2012,33(8):579-581.
[10]ARLETTAZ R,BAUSCHATZ A S,M NKHOFF M,et al.The contribution of pulse oximetry to the early detection of congenital heart disease in newborns[J].Eur J Pediatr,2006,165(2):94-98.
[11]YADLAPATI A,GROGAN T,ELASHOFF D,et al.Correlation of a novel noninvasive tissue oxygen saturation monitor to serum central venous oxygen saturation in pediatric patients with postoperative congenital cyanotic heart disease[J].J Extra Corpor Technol,2013,45(1):40-45.
[12]KAKUTA N,KAWAHITO S,MITA N J,et al.Usefulness of central venous oxygen saturation monitoring during bidirectional Glenn shunt[J].J Med Invest,2013,60(3/4):272-275.
[13]庄周颖,傅丽娟.中心静脉血氧饱和度对先天性心脏病术后患儿结局的预警价值[J].解放军护理杂志,2016,33(6):27-30.
[14]刘承虎,李玲,侯嘉,等.幼儿期先天性心脏病心脏直视术后心脏功能与氧代谢变化的对比研究[J].中华医学杂志,2012,92(44):3113-3116.
[2]HU Z,YUAN X,RAO K,et al.National trend in congenital heart disease mortality in China during 2003to 2010:a population-based study.[J].J Thorac Cardiovasc Surg,2014,148(2):596-602.e1.
[3]王定美.围孕期营养因素与先天性心脏病发病的关系[J].国际儿科学杂志,2016,43(11):840-843.
[4]LARA D A,LOPEZ K N.Public health research in congenital heart disease[J].Congenit Heart Dis,2014,9(6):549-558.
[5]KUSSMAN B D,LAUSSEN P C,BENNI P B,et al.Cerebral oxygen saturation in children with congenital heart disease and chronic hypoxemia[J].Anesth Analg,2017,125(1):234-240.
[6]王峰峰.中心静脉血氧饱和度监测在婴幼儿先心病术后的应用研究[D].郑州:郑州大学,2012.
[7]汪曾炜,刘维永,张宝仁.手术学全集心血管外科手术学[M].2版.北京:人民军医出版社,2005.
[8]张青,谢婉花,邓丽珊,等.156例复杂性先天性心脏病患儿超声检查的镇静护理[J].全科护理,2016,14(10):1034-1035.
[9]李建斌,陈欣欣,崔虎军,等.73例新生儿先天性心脏病的手术时机选择分析[J].中华小儿外科杂志,2012,33(8):579-581.
[10]ARLETTAZ R,BAUSCHATZ A S,M NKHOFF M,et al.The contribution of pulse oximetry to the early detection of congenital heart disease in newborns[J].Eur J Pediatr,2006,165(2):94-98.
[11]YADLAPATI A,GROGAN T,ELASHOFF D,et al.Correlation of a novel noninvasive tissue oxygen saturation monitor to serum central venous oxygen saturation in pediatric patients with postoperative congenital cyanotic heart disease[J].J Extra Corpor Technol,2013,45(1):40-45.
[12]KAKUTA N,KAWAHITO S,MITA N J,et al.Usefulness of central venous oxygen saturation monitoring during bidirectional Glenn shunt[J].J Med Invest,2013,60(3/4):272-275.
[13]庄周颖,傅丽娟.中心静脉血氧饱和度对先天性心脏病术后患儿结局的预警价值[J].解放军护理杂志,2016,33(6):27-30.
[14]刘承虎,李玲,侯嘉,等.幼儿期先天性心脏病心脏直视术后心脏功能与氧代谢变化的对比研究[J].中华医学杂志,2012,92(44):3113-3116.