中国医科大学学报

中国医科大学学报

中国医科大学学报 ›› 2009, Vol. 38 ›› Issue (12): 939–.

• 临床医学 • 上一篇    下一篇

体温变化对先天性心脏病小儿体外循环中脑氧供需平衡的影响

宋丹丹; 曹宇; 张铁铮; 周锦; 孙莹杰; 卢玉平; 姚婧   

  1. 沈阳军区总医院麻醉科; 中国医科大学基础医学院生理学教研室
  • 出版日期:2010-01-20 发布日期:2010-04-19
  • 通讯作者: 曹宇 E-mail:caoy5955@sina.com

Effects of Temperature Change on the Balance of Cerebral Oxygen Supply and Demand in Children of Congenital Heart Disease during Cardiopulmonary Bypass

  • Online:2010-01-20 Published:2010-04-19

摘要:

目的观察体温变化对先天性心脏病手术小儿体外循环(CPB)期间脑氧供需平衡的影响。方法选择室间隔缺损心内修复术小儿15例,分别在CPB降温期和复温期不同体温时点(T0~T7)同时抽取桡动脉和颈内静脉球部血行血气分析,计算脑氧代谢指标,包括动脉内氧含量(CaO2)、静脉内氧含量(CjvO2)、动静脉血氧含量差(AVDO2)、脑氧摄取率(CEO2),并同时检测乳酸及血糖水平。结果降温期各体温时点与基础值T0比较,颈静脉球血氧饱和度(SjvO2)显著升高(P<0.01),CaO2、AVDO2、CEO2显著降低(P<0.01);复温期各体温时点与降温期T3比较,SjvO2显著降低(P<0.01),AVDO2、CEO2均显著升高(P<0.01)。结论体温是影响先天性心脏病手术小儿CPB期间脑氧供需平衡的重要因素,降温期脑氧耗量明显降低,而复温期明显升高,较易发生脑氧供需失衡。

关键词: 温度, 体外循环, 氧代谢, 小儿, 先天性心脏病, 温度, 体外循环, 氧代谢, 小儿, 先天性心脏病

Abstract:

Objective To investigate the effects of temperature change on the
      balance of cerebral oxygen supply and demand in children of congenital
      heart disease during cardiopulmonary bypass. Methods Fifteen children of
      ventricular septal defect aged from four to nine years old were enrolled
      in the present study. Blood samples were collected simultaneously from the
      radial artery and jugular bulb respectively at different temperature
      points during hypothermic and rewarming phase of CPB for blood gas
      analysis and further calculation of cerebral oxygen consumption,including
      oxygen content of artery (CaO2),oxygen content of jugular bulb venous
      (CjvO2),the arterio-venous oxygen content difference (AVDO2)and cerebral
      extraction rate of oxygen (CEO2). At the same time,the content of blood
      glucose and lactic acid of the same blood sample were measured. Results
      Compared with data of baseline,jugular bulb venous oxygen saturation
      (SjvO2)was significantly higher (P < 0.01)and CaO2,AVDO2 and CEO2 were
      significantly lower (P < 0.01)during hypothermic phase of CPB.
      Compared with data of hypothermic phase,SjvO2 was significantly lower (P <
      0.01),however,AVDO2 and CEO2 were significantly higher during rewarming
      phase of CPB (P < 0.01). Conclusion Temperature is an important factor
      influencing the balance of cerebral oxygen supply and demand during CPB in
      children of congenital heart disease suffered cardiac surgery. The
      cerebral oxygen consumption is significantly lower during hypothermic
      phase,while higher during rewarming phase of CPB. The imbalance of
      cerebral oxygen supply and demand occurs easily during rewarming phase of
      CPB.

Key words:  temperature, cardiopulmonary bypass, oxygen metabolism, children; congenital heart disease, temperature, cardiopulmonary bypass, oxygen metabolism, children, congenital heart disease

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