局部脑氧饱和度监测在右侧腋下小切口心脏手术中的应用
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摘要
目的观察局部脑氧饱和度(r SO2)在右侧腋下小切口心脏手术中的变化。方法 2018年1～5月,选择行房间隔缺损(ASD)、室间隔缺损(VSD)修补术患儿各40例。VSD修补手术患儿采用左侧90度卧位,ASD修补手术患儿采用左侧90度卧位及头低位45度。记录患儿的一般资料以及在术前(T1)、诱导至心肺转流(CPB)开始期间(T2)、CPB降温期间(T3)、CPB降温末至CPB开始复温(T4)、CPB开始复温至CPB停机(T5)、CPB停机后20 min(T6) 6个时间段的双侧r SO2。结果全组患儿均手术顺利。其中ASD患儿组,在左侧不同时段内的比较,T3、T4、T5时间段的r SO2明显低于T1(P <0.05);而右侧不同时段内r SO2的比较,发现T3、T4、T5、T6明显低于T1(P <0.05);不同时段左、右侧的r SO2对比均无统计学差异(P>0.05)。而VSD患儿组,左侧不同时段内r SO2的比较,发现T3、T5明显低于T1(P <0.05);而右侧不同时段r SO2的比较,发现T3、T4、T5、T6均明显低于T1(P <0.05);在不同时段内,T3、T4、T5、T6的r SO2右侧均明显低于左侧(P <0.05)。结论r SO2在右侧腋下小切口心脏手术中监测有临床意义,CPB过程中r SO2会下降,停止CPB后逐步恢复至术前水平。单纯左侧90度卧位会导致左侧r SO2较右侧高。
Objective To explore the changes of regional cerebral oxygen saturation( r SO2) during cardiopulmonary bypass( CPB) through right vertical infra-axillary thoracotomy( RVIAT). Methods 80 cases undergoing cardiac surgery from January 2018 to May 2018 were enrolled in the study. Among them,there were 40 cases of ventricular septal defect( VSD) who maintained 90-degree lateral decubitus position and 40 cases of atrial septal defect( ASD) patients who kept 90-degree lateral decubitus and 45-degree head-down position. The r SO2 levels were recorded at the following time points: before surgery( T1),before anesthesia induction( T2),from induction to the beginning of CPB( T3),from the beginning of CPB to the end of nose temperature cooling( T4),from the end of nose temperature cooling to the beginning of rewarming( T5),and from the beginning of rewarming to the end of CPB( T6). All these data were analyzed by SPSS statistical software. Results All Patients underwent surgery successfully. In ASD group,compared with T1,r SO2 levels of the left side at T3,T4 and T5 were significantly lower( P <0.05) and so as the r SO2 levels of the right side at T3,T4,T5 and T6( P <0.05),while there was no significant difference between the left and right sides at all time points( P >0.05). In VSD group,compared with T1,r SO2 level of the left in T3,T5 was significantly lower than that of T1( P <0.05),however,in the right side,the r SO2 levels in T3,T4,T5,T6 were obviously lower than that of T1( P <0.05). Besides,r SO2 levels on the left side were significantly lower than those on the right side during T3,T4,T5 and T6( P <0.05). Conclusion Monitoring of r SO2 in minimally invasive cardiac surgery for children has great clinical significance. The r SO2 decreases during CPB and gradually returns to the preoperative level after CPB. 90-degree lateral decubitus position may lead to higher r SO2 on the left side.
Objective To explore the changes of regional cerebral oxygen saturation( r SO2) during cardiopulmonary bypass( CPB) through right vertical infra-axillary thoracotomy( RVIAT). Methods 80 cases undergoing cardiac surgery from January 2018 to May 2018 were enrolled in the study. Among them,there were 40 cases of ventricular septal defect( VSD) who maintained 90-degree lateral decubitus position and 40 cases of atrial septal defect( ASD) patients who kept 90-degree lateral decubitus and 45-degree head-down position. The r SO2 levels were recorded at the following time points: before surgery( T1),before anesthesia induction( T2),from induction to the beginning of CPB( T3),from the beginning of CPB to the end of nose temperature cooling( T4),from the end of nose temperature cooling to the beginning of rewarming( T5),and from the beginning of rewarming to the end of CPB( T6). All these data were analyzed by SPSS statistical software. Results All Patients underwent surgery successfully. In ASD group,compared with T1,r SO2 levels of the left side at T3,T4 and T5 were significantly lower( P <0.05) and so as the r SO2 levels of the right side at T3,T4,T5 and T6( P <0.05),while there was no significant difference between the left and right sides at all time points( P >0.05). In VSD group,compared with T1,r SO2 level of the left in T3,T5 was significantly lower than that of T1( P <0.05),however,in the right side,the r SO2 levels in T3,T4,T5,T6 were obviously lower than that of T1( P <0.05). Besides,r SO2 levels on the left side were significantly lower than those on the right side during T3,T4,T5 and T6( P <0.05). Conclusion Monitoring of r SO2 in minimally invasive cardiac surgery for children has great clinical significance. The r SO2 decreases during CPB and gradually returns to the preoperative level after CPB. 90-degree lateral decubitus position may lead to higher r SO2 on the left side.
引文
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[14] AndroPoulos DB,Diaz LK,Fraser CD,et al. Is bilateral monitoring of cerebral oxygen saturation necessary during neonatal aortic arch reconstruction[J]? Anesth Analg,2004,98(5):1267-1272.
[15] Andersen JD,Baake G,Wiis JT,et al. Effect of head rotation during surgery in the prone position on regional cerebral oxygen saturation:a prospective controlled study[J]. Eur J Anaesthesiol,2014,31(2):98-103.
[16] Laflam A,Joshi B,Brady K,et al. Shoulder surgery in the beach chair position is associated with diminished cerebral autoregulation but no differences in postoperative cognition or brain injury biomarker levels compared with supine positioning:the anesthesia patient safety foundation beach chair study[J]. Anesth Analg,2015,120(1):176-185.
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[18] Closhen D,Treiber AH,Berres M,et al. Robotic assisted prostatic surgery in the trendelenburg position does not impair cerebral oxygenation measured using two different monitors:a clinical observational study[J]. Eur J Anaesthesiol,2014,31(2):104-109.
[2]侯娇艳,徐勇,旷昕.脑氧饱和度监测在小儿麻醉中的应用进展[J].转化医学电子杂志,2018,5(5):56-59.
[3] Ghanayem NS,Hoffman GM. Near infrared spectroscopy as a hemodynamic monitor in critical illness[J]. Pediatr Crit Care Med,2016,17(1):S201-206.
[4] Sood BG,Mc Laughlin K,Cortez J. Near-infrared spectroscopy:applications in neonates[J]. Semin Fetal Neonatal Med,2015,20(3):164-172.
[5] Fischer GW,Lin HM,Krol M,et al. Noninvasive cerebral oxygenation may predict outcome in patients undergoing aortic arch surgery[J]. J Thorac Cardiovasc Surg,2011,141(3):815-821.
[6] Gómez-Pesquera E,Poves-Alvarez R,Martinez-Rafael B,et al. Cerebral Oxygen Saturation and Negative Postoperative Behavioral Changes in Pediatric Surgery:A Prospective Observational Study[J]. J Pediatr,2019,208(5):207-213.
[7] Cetin M,Birbicer H,Hallioglu O,et al. Comparative study between the effects of dexmedetomidine and propofol on cerebral oxygenation during sedation at pediatric cardiac catheterization[J].Ann Card Anaesth,2016,19(1):20-24..
[8] Suemori T,Skowno J,Horton S,et al. Cerebral oxygen saturation and tissue hemoglobin concentration as predictive markers of early postoperative outcomes after pediatric cardiac surgery[J].Paediatr Anaesth,2016,26(2):182-189.
[9] Kussman BD,Laussen PC,Benni PB,et al. Cerebral oxygen saturation in children with congenital heart disease and chronic hypoxemia[J]. Anesth Analg,2017,125(1):234-240.
[10]赵举,杨九光,刘晋萍,等.搏动体外循环增加小儿脑氧供及改善组织微循环的临床研究[J].中国体外循环杂志,2011,9(3):145-148.
[11] Kussman BD,Wypij D,Di Nardo JA,et al. An evaluation of bilateral monitoring of cerebral oxygen saturation during pediatric cardiac surgery[J]. Anesth Analg,2005,101(5):1294-1300.
[12] Saito J,Takekawa D,Kawaguchi J,et al. Preoperative cerebral and renal oxygen saturation and clinical outcomes in pediatric patients with congenital heart disease[J]. J Clin Monit Comput.2019,11(1):1-18.[Epub ahead of print]
[13] Demir ZA,Karadeniz,D9nmez A,et al. An evaluation of bilateral cerebral oxygen saturation during cyanotic and non-cyanotic cardiac surgery[J]. Turk J Thorac Cardiovasc Surg,2016,24(4):619-626.
[14] AndroPoulos DB,Diaz LK,Fraser CD,et al. Is bilateral monitoring of cerebral oxygen saturation necessary during neonatal aortic arch reconstruction[J]? Anesth Analg,2004,98(5):1267-1272.
[15] Andersen JD,Baake G,Wiis JT,et al. Effect of head rotation during surgery in the prone position on regional cerebral oxygen saturation:a prospective controlled study[J]. Eur J Anaesthesiol,2014,31(2):98-103.
[16] Laflam A,Joshi B,Brady K,et al. Shoulder surgery in the beach chair position is associated with diminished cerebral autoregulation but no differences in postoperative cognition or brain injury biomarker levels compared with supine positioning:the anesthesia patient safety foundation beach chair study[J]. Anesth Analg,2015,120(1):176-185.
[17] Moerman AT,De Hert SG,Jacobs TF,et al. Cerebral oxygen desaturation during beach chair position[J]. Eur J Anaesthesiol,2012,29(2):82-87.
[18] Closhen D,Treiber AH,Berres M,et al. Robotic assisted prostatic surgery in the trendelenburg position does not impair cerebral oxygenation measured using two different monitors:a clinical observational study[J]. Eur J Anaesthesiol,2014,31(2):104-109.