Glenn手术围术期脑氧代谢的研究

目的:研究Glenn手术后早期脑部淤血状态对脑氧代谢的影响。方法:选择紫绀型先心病行双向Glenn手术的患儿50例,根据术后CVP高低分为两组,C组为低CVP(CVP最高不超过13mmHg)20例,P组为高CVP组(CVP最低不小于13mmHg)30例,利用近红外光谱(NIRS)分别检测术前(未吸氧)、术前(麻醉诱导)、术后2h、术后24h、术后3d、术后5d的TOI,同时记录术后各点的CVP、BP、HR、SPO2等。结果:两组病例的年龄、性别、体重、射血分数、手术时间、体外循环时间、经皮氧饱和度、平均动脉压等差异均无统计学意义。两组病例术后TOI较术前均有升高(P<0.05),T0～T2TOI在C组与P组差异无统计学意义,T3～T5P组的TOI值高于C组,且在CVP超过19mmHg时TOI与CVP相关性较高(相关系数为-0.788,P<0.001)。结论:Glenn手术术后早期脑氧代谢失衡,并且与CVP的增高程度相关。

Research on Glenn operation cerebral oxygen metabolism in patients undergoing Glenn operation

Objective: To evaluate the influence of cerebral haemostasis on cerebral oxygen metabolism in patients undergoing Glenn operation.Methods: Fifty cases of cyanotic congenital heart disease were selected for Glenn bidirectional operation,and were divided into two groups according to CVP level after operation.Group C(20 cases,CVP ≤13 mmHg),Group P(30 cases,CVP ≥13 mmHg),Cerebral oxygen saturation and CVP,BP,HR,SPO2 were detected and recorded with the method of near infrared spectroscopy(NIRS) at following time points including before detection(without oxygen inhalation),before operation(induction of anesthesia),2 h after surgery,24h after surgery,3 day after surgery,5 day after surgery respectively.Results: There were no statistically significant difference in age,gender,weight,ejection fraction,operation time,cardiopulmonary bypass time,transcutaneous oxygen saturation,and mean arterial pressure between the two groups.Postoperative TOI level were significant higher than that before the operation in both groups(P<0.05).No significant difference in TOI level at T0～T2 as found between group C and group P but TOI at T3～T5 in group P was significant higher than that in group C.Besides,when CVP was higher than 19 mmHg,TOI was more obviously correlated with CVP(Correlation coefficient-0.788,P<0.001).Conclusions: The imbalanced cerebral oxygen metabolism in early stage after Glenn operation is correlated with the increase of CVP for patients undergoing the operation.