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| 机械通气对室间隔缺损患儿脑氧合和脑血流速度的影响 |
| Effects of mechanical ventilation on cerebral oxygenation and cerebral blood flow velocity in infants with ventricular septal defect |
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| DOI：10.12089/jca.2019.06.003 |
| 中文关键词: 室间隔缺损 机械通气 脑氧饱和度 大脑中动脉血流速度 |
| 英文关键词: septal defect Mechanical ventilation Cerebral oxygen saturation Cerebral blood flow velocity |
| 基金项目:北京市医院管理局临床医学发展专项经费资助(ZYLX201810) |
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| 中文摘要: |
目的 探讨麻醉诱导期间机械通气变化对室间隔缺损（ventricular septal defect, VSD）修补术患儿区域脑组织氧饱和度（regional cerebral oxygen saturation, rScO2）和大脑中动脉血流速度（cerebral blood flow velocity, CBFV）的影响。
方法 选择VSD修补术患儿67例，男34例，女33例，年龄<1岁，体重3.4～11.0 kg，ASA Ⅱ或Ⅲ级。入室麻醉诱导后气管插管，调整通气参数使PETCO2初始值为30 mmHg（T30）。持续使用Fore-Sight实时监测右侧额部rScO2，TCD间断测量CBFV收缩期、CBFV舒张期、CBFV平均值。通过调整通气参数使PETCO2逐渐上升至35 mmHg（T35）、40 mmHg（T40）、45 mmHg（T45），记录对应的CBFV值以及rScO2，计算每分钟通气量（MV）和T30—T35、T35—T40、T40—T45三个时段的脑血管CO2反应性（CO2R）。
结果 T30—T45时rScO2、CBFV收缩期、CBFV舒张期、CBFV平均值均明显增大（P<0.01），PI、RI均明显减小（P<0.01）。T35—T40时CO2R在最高值。
结论 室间隔缺损患儿在麻醉诱导阶段，机械通气对脑氧合和大脑中动脉脑血流速度有明显影响，正常低通气能明显增加脑氧合和脑血流速度。 |
| 英文摘要: |
Ojective To monitor the regional cerebral oxygen saturation (rScO2) and middle cerebral artery blood flow velocity (CBFV) by using near infrared spectroscopy (NIRS), and analyze the effect of mechanical ventilation on rScO2 and CBFV in infants who undergoing ventricular septal defect (VSD) repair during anesthesia induction.
Methods Sixty-seven patients undergoing VSD repair, 34 males and 33 females, aged < 1 years, weighing 3.4 - 11.0 kg, falling into ASA physical status Ⅱ or Ⅲ, were enrolled. After admission, anesthesia induction and intubation. By means of adjusting tidal volume (VT, ml/kg) and respiratory rate (RR), PETCO2 was maintained at initial value of 30 mmHg (T30). The right side of rScO2 was monitored by real-time Fore-Sight, CBFV was measured intermittently by TCD (including systolic, diastolic phasemean and mean CBFV, pulsation index, resistance index). By adjusting VT and RR, PETCO2 was gradually increased to 35 mmHg (T35), 40 mmHg (T40), and 45 mmHg (T45). rScO2, CBFV were recorded and ventilation (MV) was calculated at T30, T35, T40 and T45. The CO2 reactivity(CO2R) of T30 - T35, T35 - T40 and T40 - T45 was calculated.
Results The rScO2, CBFVsystolic, CBFVdiastole and CBFVmean increased significantly (P < 0.01), PI and RI were significantly decreased (P < 0.01) at T30 - T45. The CO2R at T35 - T40 was at the highest value.
Conclusion Mechanical ventilation has obvious influence on rScO2 and CBFV in infants who underwent VSD repair during induction of anesthesia. Normal hypoventilation can significantly increase cerebral oxygenation and cerebral blood flow velocity. |
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