摘要
目的:应用SedLine大脑功能监测记录婴儿脑电谱缘频率(SEF),近红外光谱法监测区域脑组织氧饱和度(rScO2),经颅多普勒脑血流仪(TCD)测量大脑中动脉血流速度(CBFV),分析行室间隔缺损(VSD)修补术婴儿在麻醉状态下,潮气末二氧化碳(PetCO2)变化对脑电SEF和脑血流动力学的影响。方法:选择1岁以下择期行室间隔缺损修补术的婴儿57例。入室行全麻诱导及气管插管后,调整潮气量(Vt,mL/kg)和呼吸频率(F)使PetCO2初始值为30 mmHg(1mmHg=0.133 kPa,T30)。持续使用SedLine监测脑电SEF,Fore-Sight实时监测右侧额部rScO2,应用TCD间断测量CBFV(包括收缩期和舒张期以及平均脑血流速度),经桡动脉测量有创动脉血压。通过调整Vt和F使PetCO2逐渐上升至35 mmHg(T35)、40 mmHg(T40)、45 mmHg(T45),于T30、T35、T40、T45点测量CBFV,记录脑电SEF、rScO2、脉搏氧饱和度(SPO2)、心率(HR)、收缩压(SBP)、舒张压(DBP)。结果:组内比较,T30到T45过程中,脑电SEF明显下降(P<0.001),rScO2、CBFV收缩、CBFV舒张、CBFV平均值均显著增加(P<0.001)。②相关性分析,T30~T45过程中脑电SEF与rScO2、CBFV收缩、CBFV舒张、CBFV平均、BP均呈显著正相关(P<0.05)。结论:室间隔缺损婴儿在麻醉状态下,PetCO2对脑电SEF和脑血流动力学有明显影响;正常高PetCO2状态下,脑氧供更高、氧耗量更低,氧供需平衡更优化。
Objective:By using sedline brain function monitoring to record the spectral edge frequency(SEF)of EEG,near infrared spectroscopy(NIRS)to monitor regional cerebral oxygen saturation(rScO2),transcranial Doppler(TCD)to measure the cerebral blood flow velocity(CBFV),to analyze the effect of end-tidal carbon dioxide(PetCO2)on EEG SEF and cerebral hemodynamics during anesthesia induction in infants undergoing VSD repair.Methods:A total of 57 patients were enrolled.After anesthesia induction and tracheal intubation,adjust the tidal volume(Vt,mL/kg)and respiratory frequency(F)so that the initial value of Pet-CO2 is 30mmhg(T30).The right side of rScO2 was monitored by real-time Fore-Sight,CBFV was measured in-termittently by TCD(including systolic,diastolic and mean CBFV),and arterial blood pressure was measured through the radial artery.By adjusting Vt and F,PetCO2was gradually increased to 35 mmHg(T35),40 mmHg(T40),and 45 mmHg(T45).EEG SEF,rScO2,CBFV,SpO2,HR,SBP,DBP were recorded at T30,T35,T40 and T45.Results:EEG SEF were significantly decreased(P<0.001),rScO2,CBFVsystolic,CBFVdiastolic and CBFVmean increased significantly(P<0.001)from T30 to T45.②During T30 to T45,EEG SEF was positively cor-related with rScO2,CBFV(CBFVsystolic,CBFVdiastole and CBFVmean),and BP(P<0.05).Conclusions:PetCO2 affects EEG SEF and cerebral hemodynamics dramatically in infants undergoing VSD repair under anesthesia.In normal high PetCO2 state,brain oxygen supply is higher,oxygen consumption is lower,and oxygen supply-de-mand balance is more optimized.
作者
谢思远
马骏
欧阳川
张冬妮
XIE Siyuan;MA Jun;OUYANG Chuan;ZHANG Dongni(Department of Anesthesiology,Capital Institute of Pediatrics Affiliated Children’s Hospital,Beijing 100020,China)
出处
《心肺血管病杂志》
2020年第12期1482-1485,共4页
Journal of Cardiovascular and Pulmonary Diseases
关键词
婴儿
室间隔缺损
脑电
脑氧饱和度
大脑中动脉血流速度
Infant
Ventricular septal defect
EEG edge frequency
Cerebral oxygen saturation
Cerebral blood flow velocity
