中国医科大学学报

中国医科大学学报
  • 中文核心期刊
  • 中国科技核心期刊
  • 中国高校百佳科技期刊
  • BA、CA收录

中国医科大学学报 ›› 2018, Vol. 47 ›› Issue (5): 385-389.doi: 10.12007/j.issn.0258-4646.2018.05.001

• 论著 •    下一篇

肺保护性通气策略在新生儿胸腔镜手术中对脑氧饱和度的影响

万玉骁, 朱俊超   

  1. 中国医科大学附属盛京医院麻醉科, 沈阳 110004
  • 收稿日期:2018-03-25 出版日期:2018-05-30 发布日期:2018-04-27
  • 通讯作者: 朱俊超 E-mail:zhujc@sj-hospital.org
  • 作者简介:万玉骁(1986-),男,医师,硕士.
  • 基金资助:
    国家自然科学基金(81401231)

Effect of Pulmonary Protective Ventilation on Cerebral Oxygen Saturation during Thoracoscopic Surgery in Neonates

WAN Yuxiao, ZHU Junchao   

  1. Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang 110004, China
  • Received:2018-03-25 Online:2018-05-30 Published:2018-04-27

摘要: 目的 探讨肺保护性通气策略(PPVS)在新生儿胸腔镜手术中对患儿脑氧饱和度(cSO2)的影响。方法 选取行先天性食道闭锁/气管食管瘘(EA/TEF)和先天性膈疝(CDH)修补术的新生儿共20例,随机均分为保护性通气组(P组)和传统通气组(C组,即对照组)。诱导插管,建立人工气胸。调整呼吸参数,P组以PPVS使动脉血二氧化碳分压(PaCO2)<80 mmHg。C组以常规通气方式,使PaCO2维持在35~45 mmHg。取插管机械通气后(T0)、气胸后30 min (T1)、气胸后60 min (T2)、气胸后90 min (T3)和气胸解除后30 min (T4)共5个观测时点,行动脉采血分析,同时以近红外光谱仪测量cSO2结果 T1~T3时点P组患儿的PaCO2明显高于C组,动脉血气pH值明显低于C组(P < 0.05),T1~T4各时点两者PaO2均无统计学差异(P > 0.05)。在T1~T3时点P组cSO2显著低于C组(P < 0.05)。T4时点2组PaCO2、动脉血pH值差异无统计学意义(P > 0.05)。结论 PPVS在新生儿胸腔镜手术中产生的高碳酸血症及酸中毒可导致一过性cSO2降低。

关键词: 保护性通气策略, 高碳酸血症, 酸中毒, 脑氧饱和度

Abstract: Objective To explore the effect of pulmonary protective ventilation(PPV)on cerebral oxygen saturation(cSO2)in neonates during thoracoscopic surgery.Methods We selected 20 neonates with congenital esophageal atresia or with esophageal atresia/tracheoesophageal fistula(EA/TEF)and congenital diaphragmatic hernia(CDH). All neonates were randomly divided into the protective ventilation group(group P)and traditional ventilation group(group C). Artificial pneumothorax was established after endotracheal intubation. After the adjustment of breathing parameters,PaCO2 was maintained at < 80 mmHg with PPV. For group C,the PaCO2 was maintained between 35-45 mmHg,which is same as the traditional ventilation parameter. The cSO2 in the arterial blood was examined at 5 time points using near-infrared spectrometry.Results At T1-T3,the PaCO2 of arterial blood for group P was significantly higher than that for group C (P < 0.05),whereas the pH of arterial blood gas for group P was significantly lower than that for group C(P < 0.05). At T1-T4,the PaO2 of arterial blood was not significantly different between the two groups(P > 0.05). At T1-T3,the brain oxygen saturation was significantly lower in group P than that in group C(P < 0.05). At T4,there was no significant difference in the values of pH and PaCO2 of arterial blood between the two groups(P > 0.05).Conclusion Hypercapnia and acidosis caused by PPV in neonatal thoracoscopic surgery can lead to lower cSO2.

Key words: protective ventilation strategy, hypercapnia, acidosis, cerebral oxygen saturation

中图分类号: 

  • R614.2
[1] LOBE TE,ROTHENBERG S,WALDSCHMIDT J,et al. Thoracoscopic repair of esophageal atresia in an infant:a surgical first[J]. Pediatr Endosurg Inno Tech,2000,3(3):141-148. DOI:10.1089/pei.1999.3.141.
[2] PONSKY TA,ROTHENBERG SS. Minimally invasive surgery in infants less than 5 kg:experience of 649 cases[J]. Surg Endosc,2008, 22(10):2214-2219. DOI:10.1007/s00464-008-0025-7.
[3] Ure BM,SCHMIDT AI,JESCH NK. Thoracoscopic surgery in infants and children[J]. Eur J Pediatr Surg,2005,15(5):314-318. DOI:10.1055/s-2005-865793.
[4] BLISS D,MATAR M,KRISHNASWAMI S. Should intraoperative hypercapnea or hypercarbia raise concern in neonates undergoing thoracoscopic repair of diaphragmatic hernia of bochdalek?[J]. J Laparoendosc Adv Surg Tech A,2009,19(4):55-58. DOI:10.1089/lap.2008.0141.
[5] FISHMAN JR,BLACKBUM SC,JONES NJ,et al. Does thoracoscopic congenital diaphragmatic hernia repair cause a significant intraoperative acidosis when compared to an open abdominal approach?[J]. J Pediatr Surg,2011,46(3):458-461. DOI:10.1016/j.jpedsurg.2010.08.062
[6] GOURLAY DM,CCASSIDY LD,SATO TT,et al. Beyond feasibility:a comparison of newborns undergoing thoracoscopic and open repair of congenital diaphragmatic hernias[J]. J Pediatr Surg,2009,44(9):1702-1707. DOI:10.1016/j.jpedsurg.2008.11.030.
[7] KROSNAR S,BAXTER A. Thoracoscopic repair of esophageal atresiawith tracheoesophageal fistula:anesthetic and intensive care management of a series of eight neonates[J]. Paediatr Anaesth,2005,15(7):541-546. DOI:10.1111/j.1460-9592.2005.01594.x.
[8] MCHONEY M,GIACOMELLO L,NAH SA,et al. Thoracoscopic repair of congenital diaphragmatic hernia:intraoperative ventilation and recurrence[J]. J Pediatr Surg,2010,45(2):355-359. DOI:10.1016/j.jpedsurg.2009.10.072.
[9] BISHAY M,GIACOMELLO L,RETROSI G,et al. Hypercapnia and acidosis during open and thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia:results of a pilot randomized controlled trial[J]. Ann Surg,2013,258(6):895-900. DOI:10.1097/SLA.0b013e31828fab55.
[10] HIGGINS BD,CMSTELLO JF,CHONGHAILE MN,et al. Permissive hypercapnia in protective lung ventilatory strategies[J]. Paediatr Child Health,2007,17(3):94-103. DOI:10.1016/j.paed.2007.01.014.
[11] 胡华琨,李强,彭夕华. 允许性高碳酸血症在新生儿胸腔镜先天性膈疝修补术中的应用[J]. 临床麻醉学杂志,2014,30(8):766-769.
[12] GUIDRY CA,HRANJEC T,RODGERS BM,et al. Permissive hypercapnia in the management of congenital diaphragmatic hernia:our institutional experience[J]. J Am Coll Surg,2012,214(4):640-645. DOI:10.1016/j.jamcollsurg.2011.12.036.
[13] NEUNHOEFFER F,WARMANN SW,HOFBECK M,et al. Elevated intrathoracic CO2 pressure during thoracoscopic surgery decreases regional cerebral oxygen saturation in neonates and infants-A pilot study[J]. Paediatr Anaesth,2017,27(7):752-759. DOI:10.1111/pan.13161.
[14] BISHAY M,GIACOMELLO L. Decreased cerebral oxygen saturation during thoracoscopic repair of congenital diaphragmatic hernia and esophageal atresia in infants[J]. J Pediatr Surg,2011,46(1):47-51. DOI:10.1016/j.jpedsurg.2010.09.062.
[15] Ⅲ EHA,JR HLE,AUDEN SM,et al. Benefit of neurophysiologic monitoring for pediatric cardiac surgery[J]. J Thorac Cardiovasc Surg,1997,114(5):707-717. DOI:10.1016/S0022-5223(97) 70074-6.
[16] ORIHASHI K,SUEDA T,OKADA K,et al. Near-infrared spectroscopy for monitoring cerebral ischemia during selective cerebral perfusion[J]. Eur J Cardiothorac Surg,2004,26(5):907-911. DOI:10.1016/j.ejcts.2004.06.014.
[17] HEMMERLING TM,BLUTEAU MC,KAZAN R,et al. Significant decrease of cerebral oxygen saturation during single-lung ventilation measured using absolute oximetry[J]. Br J Anaesth,2008,101(6):870-875. DOI:10.1093/bja/aen275.
[18] NEWMAN MF,GROCOTT HP,MATHEW JP,et al. Report of the substudy assessing the impact of neurocognitive function on quality of life 5 years after cardiac surgery[J]. Stroke,2001,32(12):2874-2881. DOI:https://doi.org/10.1161/hs1201.099803.
[19] MORTELLARO VE,FIKE FB,ADIBE OO,et al. The use of high-frequency oscillating ventilation to facilitate stability during neonatal thoracoscopic operations[J]. J Laparoendosc Adv Surg Tech A,2011,21(9):877-879. DOI:10.1089/lap.2011.0134.
[20] TADAHARU O,MANABU O,JUNYA I,et al. Intraoperative ventilation during thoracoscopic repair of neonatal congenital diaphragmatic hernia[J]. Pediatr Surg Int,2017,33(10):1097-1101. DOI:10.1007/s00383-017-4143-y.
[1] 孙聪, 皮晓丽, 陈莹, 刘刚, 王俊. 术中脑氧饱和度监测对心血管手术患者术后认知功能障碍发生率的影响[J]. 中国医科大学学报, 2018, 47(7): 631-636.
[2] 王浩宇,赖亚新. 暴发性 1 型糖尿病 2 例并文献复习[J]. 中国医科大学学报, 2017, 46(5): 467-469.
[3] 邱爽,董有静,段丽芳,孙越. 七氟烷与异丙酚对老年肺癌患者局部脑氧饱和度及术后早期 认知功能的影响[J]. 中国医科大学学报, 2016, 45(9): 797-800.
[4] 朱俊超,杨延超,滕秀飞,金宁,白文娅,刘诗煜,史胜哲. 甲强龙联合经皮穴位电刺激对老年患者术后认知功能的影响[J]. 中国医科大学学报, 2016, 45(3): 233-236.
[5] 侯大亮,吴秀英. 右美托咪定对开腹手术中老年患者脑氧饱和度及 术后认知功能的影响[J]. 中国医科大学学报, 2016, 45(11): 1039-1042.
[6] 黄昕,滕秀飞,杨延超,李秀艳,魏巍,朱俊超. 低血红蛋白对全麻患者脑氧饱和度及术后认知功能的影响[J]. 中国医科大学学报, 2016, 45(1): 35-38.
[7] 李静, 邱冰, 陈莹, 单忠艳. 急性型1型糖尿病临床特征的性别差异研究[J]. 中国医科大学学报, 2010, 39(1): 54-.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!

中国医科大学学报版权所有©2018

未经允许,严禁擅自转载本站图文资料

地址:中国 沈阳市沈北新区蒲河路77号 110122

辽ICP备05014850

JOURNAL OF CHINA MEDICAL UNIVERSITY

ADDRESS: NO.77 PUHE ROAD

SHENYANG NORTH NEW AREA, SHENYANG

LIAONING PROVINCE, P.R. CHINA