肾氧饱和度监测在婴幼儿非紫绀型先心病手术中的应用及临床意义

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摘要目的探讨术中采用连续肾氧饱和度监测的临床意义。方法选择2017年1~11月深圳市儿童医院手术治疗的3个月~3岁非紫绀型先心病患儿50例。采用舒芬太尼-七氟醚静吸复合气管插管麻醉。记录麻醉前（t0）、麻醉开始5 min（t1）、手术开始5 min（t2）、体外循环开始5 min（t3）、体外循环开始15 min（t4）、开放升主动脉5 min（t5）、停机5 min（t6）及手术结束（t7）等时点的肾氧饱和度（RrSO2）、脑氧饱和度（CrSO2）、平均动脉压（MAP）、鼻温、肛温等变化。结果 t3、t4、t5、t6、t7时的RrSO2、CrSO2高于t0时RrSO2、CrSO2，差异有统计学意义（P < 0.05）。RrSO2与CrSO2呈正相关（r = 0.682，P = 0.000），与MAP呈正相关（r = 0.258，P = 0.061），与鼻温、肛温呈负相关（r = -0.169、-0.166，P = 0.083、0.101）。CrSO2与MAP呈正相关（r = 0.287，P = 0.076），与鼻温、肛温呈负相关（r = -0.177、 -0.180，P = 0.064、0.097）。体循环前、体循环中、体循环后二氧化碳分压、氧分压、血乳酸值、尿素氮值比较，差异均无统计学意义（P > 0.05），进一步两两比较亦无统计学差异（P > 0.05）。结论肾氧饱和度监测可以作为一种新的反映肾脏氧合状态的监测手段应用在婴幼儿非紫绀型先心病手术中。

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	谢越涛邢大军▲ 姚翠翠马星刚王嫦娥

关键词 ：肾氧饱和度, 婴幼儿, 非紫绀型先心病 ,

Abstract：Objective To explore the clinical significance of continuous renal oxygen saturation monitoring. Methods Fifty cases 3 months - 3 years old children with acyanotic congenital heart disease accepted surgical treatment from January to November 2017 in Shenzhen Children Hospital were selected. Sufentanil Sevoflurane inhalation combined with tracheal intubation anesthesia were used. At the time point of before anesthesia (t0), 5 min after anesthesia (t1), 5 min after operation (t2), 5 min after cardiopulmonary bypass (t3), 15 min after cardiopulmonary bypass (t4) the beginning of CPB, after open aortic 5 min (t5), 5 min after closing the anaesthesia machine (t6) and ending of the surgery (t7), the renal regional oxygenation saturation (RrSO2), cerebral regional oxygen saturation (CrSO2), mean arterial pressure (MAP), the nose temperature and rectal temperature and other changes were recorded. Results At the time point of t3, t4, t5, t6, t7, RrSO2 and CrSO2 were higher than t0, the differences were statistically significant (P < 0.05). RrSO2 was positively correlated with CrSO2 (r = 0.682, P = 0.000), and RrSO2 was positively correlated with MAP (r = 0.258, P = 0.061), and negatively correlated with nose temperature, rectal temperature （r = -0.169, -0.166, P = 0.083, 0.101). There was a positive correlation between CrSO2 and MAP (r = 0.287, P = 0.076), CrSO2 was negatively correlated with nose temperature, rectal temperature (r = -0.177, -0.180, P = 0.064, 0.097). There was no significant difference in PO2, blood lactate and urea nitrogen before and after systemic circulation after systemic circulation. There was no significant difference in PCO2, PO2, blood lactate and urea nitrogen between before systemic circulation, during systemic circulation, after systemic circulation (P > 0.05), comparison between any two means, the differences were not statistically significant (P > 0.05). Conclusion Renal oxygen saturation monitoring can be used as a new renal oxygenation monitoring application in infants with congenital heart disease surgery.

Key words： Renal oxygen saturation Infants Noncyanotic congenital heart disease

基金资助:广东省深圳市知识创新计划基础研究项目（JCYJ20160429175948904）。

通讯作者: ▲通讯作者

引用本文:

谢越涛邢大军▲ 姚翠翠马星刚王嫦娥. 肾氧饱和度监测在婴幼儿非紫绀型先心病手术中的应用及临床意义[J]. 中国医药导报, 2018, 15(18): 154-157.
XIE Yuetao XING Dajun▲ YAO Cuicui MA Xinggang WANG Change. Application and clinical significance of renal oxygen saturation monitoring in infants with noncyanotic congenital heart disease surgery. 中国医药导报, 2018, 15(18): 154-157.

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