文章摘要
不同呼气末二氧化碳分压对室间隔缺损修补术患儿脑氧合及脑血流的影响
Effect of different end-tidal carbon dioxide partial pressure on cerebral oxygenation and cerebral blood flow in infants with ventricular septal defect repair
  
DOI：10.12089/jca.2019.05.002
中文关键词: 区域脑氧饱和度  脑血流  呼末二氧化碳  先天性心脏病
英文关键词: Regional cerebral oxygen saturation  Cerebral blood flow  End-tidal carbon dioxide partial pressure  Congenital heart disease
基金项目:
作者单位E-mail
崔博群 100029,首都医科大学附属北京安贞医院麻醉中心  
谢思远 首都儿科研究所附属儿童医院麻醉科  
马骏 100029,首都医科大学附属北京安贞医院麻醉中心  
欧阳川 100029,首都医科大学附属北京安贞医院麻醉中心 163-hys@163.com 
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中文摘要:
      
目的 探讨不同PETCO2对室间隔缺损修补术患儿脑氧合及脑血流的影响。
方法 择期行室间隔缺损修补术患儿60例，随机分为两组，每组30例。低通气组（L组）：调控VT和RR，以维持PETCO2在40～45 mmHg；高通气组（H组）：调控VT和RR，以维持PETCO2在35～40 mmHg。记录麻醉诱导后（T0）、开心包（T1）、CPB结束（T2）、改良超滤结束（T3）、术毕（T4）时的局部脑氧饱和度（rScO2）以及右侧大脑中动脉血流平均速度（VMCA）、搏动指数（PI）和阻力指数（RI）。
结果 与T2时比较，T0、T1、T3、T4时两组患儿rScO2和VMCA明显升高（P<0.05），PI和RI明显降低（P<0.05）。T0、T1、T3、T4时L组rScO2和VMCA明显高于H组（P<0.05）。
结论 PETCO2在40~45 mmHg时，患儿rScO2和VMCA高于PETCO2在35~40 mmHg时，可改善脑氧供需平衡。
英文摘要:
      
Ojective To analyze the change of different PETCO2 on regional cerebral oxygen saturation (rScO2) and cerebral blood flow in infants with ventricular septal defect repair.
Methods In this study, 60 infants with VSD were randomly divided into high ventilation group (group H, 30 cases) and low ventilation group (group L, 30 cases). PETCO2 was maintained at 40 - 45 mmHg by regulating VT and RR in group L. PETCO2 was maintained at 35 - 40 mmHg by regulating VT and RR in group H. The values of rScO2, flow velocity of middle cerebral artery (VMCA) at the right side, pulse index (PI) and resistance index(RI) were recorded respectively after anesthesia (T0), cut pericardium (T1), the end of CPB (T2), the end of modified ultrafiltration (T3), after operation (T4).
Results Compared with T2, the values of rScO2 and VMCA were significantly increased while the levels of PI and RI were decreased at T0, T1, T3, T4 (P<0.05). Meanwhile, the levels of rScO2 and VMCA in group L were higher than those in group H (P<0.05).
Conclusion The infants' rScO2 and VMCA performed better when PETCO2 is 40-45 mmHg versus 35-40 mmHg, which could improve the balance of cerebral oxygen supply and demand.
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