CrSO<sub>2</sub>联合Pcv-aCO<sub>2</sub>对发绀型婴幼儿心脏手术后ICU停留时间的预测意义

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摘要目的探究脑氧饱和度(cerebral oxygen saturation,CrSO₂)联合中心静脉动脉二氧化碳分压差(central venous arterial carbon dioxide partial pressure difference, Pcv-aCO₂)对发绀型婴幼儿心脏手术后ICU停留时间的预测意义。方法选取2018年6-12月在解放军总医院第七医学中心心肺转流(cardiopulmonary bypass, CPB)下接受心脏手术的0~1岁发绀型先心病患儿30例,分别于气管插管开放动静脉后(t₁)、升主动脉夹闭后5 min(t₂)、升主动脉开放后5 min(t₃)、 CPB结束(t₄)、CPB结束后3 h(t₅)、CPB结束后8 h(t₆)、CPB结束后24 h(t₇)记录CrSO₂、动脉血二氧化碳分压(PaCO₂)、中心静脉血二氧化碳分压(PcvCO₂),动脉血孔酸(Lac)、动脉血氧饱和度(SaO₂)、动脉血红蛋白(Hb)、平均动脉压(MAP)、温度氧咽温(T)并计算 Pcv-aCO₂;记录术后ICU停留时间。比较S组(ICU停留时间≤9 d)、L组(ICU停留时间＞9 d)的患儿围术期Lac、CrSO₂、Pcv-aCO₂、SaO₂、Hb、MAP、T的差异,分析Lac、CrSO₂、Pcv-aCO₂对发绀型婴幼儿心脏手术后ICU停留时间的预测意义。结果 S组、L组两组患儿Lac在t₁、t₂、t₃、t₄、t₅、t₆、t₇差异均无统计学意义;与S组相比, L组CrSO₂在t₁、t₂、t₃、t₄明显降低[(53.33±4.38)% &(59.33±4.38)%、(56.83±3.51)% &(63.00±3.67)%、(47.48±5.65)% &(52.51±2.54)%、(44.58±2.42)% &(49.44±3.60)%],t₅、t₆、t₇两组患儿CrSO₂差异无统计学意义;与S组相比,L组Pcv-aCO₂在t₁、t₂、t₃、t₄差异无统计学意义(P＞0.05),在t₅、t₆、t₇明显增高[(16.67±5.28)mmHg &(9.63±3.98)mmHg、(21.83±6.15)mmHg &(12.71±3.10)mmHg、(13.00±2.65)mmHg &(7.36±3.03)]。 S组和L组各时间点PaCO₂、SaO₂、Hb、MAP、T比较,差异均无统计学意义。结论 CPB期间CrSO₂ 降低、CPB结束后 Pcv-aCO₂ 升高对ICU停留时间延长有预测作用。

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	魏碧玉
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关键词 ：婴幼儿, 心肺转流, 脑氧饱和度, 中心静脉动脉二氧化碳分压差

Abstract：Objective To investigate the potential of cerebral oxygen saturation (CrSO₂) combined with central venous arterial carbon dioxide partial pressure difference (Pcv-aCO₂) to predict the length of stay in the ICU for cyanotic infants after cardiac surgery.Methods Thirty children of 0-1 year old with cyanotic congenital heart disease who underwent cardiac surgery under cardiopulmonary bypass (CPB) between June and December 2018 in the Seventh Medical Center of Chinese PLA General Hospital were selected. CrSO₂, arterial blood carbon dioxide partial pressure (PaCO₂), central venous blood carbon dioxide partial pressure (PcvCO₂)、Lac、SaO₂、Hb、MAP and T of these patients were recorded immediately after tracheal intubation and open arteriovenous (t₁), 5 minutes after ascending aortic clamping (t₂), 5 minutes after the ascending aorta was opened (t₃), at the end of CPB(t₄), 3 h after the end of CPB (t₅), 8 h after the end of CPB (t₆), 24 h after the end of CPB (t₇). Pcv-aCO₂ was calculated while postoperative length of ICU stay was recorded. The difference of perioperative Lac, CrSO₂ SaO₂、Hb、MAP、T and Pcv-aCO₂ was compared between group S (length of stay in the ICU ≤ 9 days) and group L (length of stay in the ICU>9 days). The extent to which CrSO₂ combined with Pcv-aCO₂ could help predict the length of stay in the ICU for cyanotic infants after cardiac surgery was analyzed.Results There was no significant difference in Lac between group S and group L at t₁, t₂, t₃, t₄, t₅, t₆ or t₇.Compared with group S, CrSO₂ of group L was significantly reduced at t₁, t₂, t₃, and t₄ [(53.33±4.38)% & (59.33±4.38)%, (56.83±3.51)% & (63.00±3.67)%, (47.48±5.65)% & (52.51±2.54)%, (44.58±2.42)% & (49.44±3.60)%], but there was no significant difference in CrSO₂ at t₅, t₆ and t₇.Compared with group S, Pcv-aCO₂ in group L was not significantly different at t₁, t₂, t₃, and t₄, but increased significantly at t₅, t₆, and t₇ [(16.67±5.28)mmHg & (9.63±3.98) mmHg, (21.83±6.15) mmHg & (12.71±3.10)mmHg, (13.00±2.65)mmHg & (7.36±3.03)]. There was no significant difference in PaCO₂, SaO₂, Hb, MAP and T between group S and group L at each time point.Conclusions The decrease of CrSO₂ during CPB and the increase of Pcv-aCO₂ after CPB can help predict the extension of length of stay in the ICU.

Key words： infant cardiopulmonary bypass cerebral oxygen saturction central venous arterial carbon dioxide partial pressure difference

收稿日期: 2019-03-06

ZTFLH:

R614

基金资助:北京市科技委员会基金资助项目(Z1711000000417035)

通讯作者: 高明龙,E-mail: gaominglongg@163.com

作者简介: 魏碧玉,硕士研究生,住院医师。

引用本文:

魏碧玉, 刘永哲, 常宇飞, 高明龙. CrSO₂联合Pcv-aCO₂对发绀型婴幼儿心脏手术后ICU停留时间的预测意义[J]. 武警医学, 2019, 30(11): 952-955. WEI Biyu, LIU Yongzhe, CHANG Yufei, GAO Minglong. Potential of CrSO₂ combined with Pcv-aCO₂ to predict length of stay in ICU after cardiac surgery in cyanotic infants. Med. J. Chin. Peop. Armed Poli. Forc., 2019, 30(11): 952-955.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2019/V30/I11/952

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