You Position: Home > Paper
The cardiocerebral protection of different levels of partial pressure of arterial carbon dioxide for the infants undergoing ventricular septal defect repair
( views:7, downloads:6 )
- Author:
- No author available
- Journal Title:
- China Medicine
- Issue:
- 2
- DOI:
- 10.3760/j.issn.1673-4777.2023.02.009
- Key Word:
- 先天性心脏病;器官损伤;二氧化碳
Abstract： 目的 探究不同水平动脉血二氧化碳分压(PaCO2)对室间隔缺损修补术婴儿的心脑保护作用.方法 回顾性分析首都医科大学附属北京安贞医院2017 年5 月至2018 年5 月83 例行室间隔缺损修补术婴儿的资料.采用呼气末二氧化碳分压(PETCO2)作为间接的、持续性指标来反映PaCO2,记录术前(T1)、切心包(T2)、停体外循环(T3)、停超滤(T4)及术毕(T5)时点的PETCO2,除T3 时点PaCO2 不受呼吸条件影响外,在其余时点 PETCO2 为 30~<40 mmHg(1 mmHg = 0.133 kPa)的婴儿为低二氧化碳组(LP组,34 例),PETCO2 为40~<50 mmHg的婴儿为高二氧化碳组(HP组,49 例).记录实验室指标,T1、T4 时点动脉血气分析结果,T1~T5 时点呼吸参数、局部脑氧饱和度(rScO2)、脑血流参数及血流动力学参数.结果 术后 1 d,2 组肌酸激酶同工酶水平均高于术前 3 d,但 HP组低于 LP组(P<0.05).HP组T1、T4 时点PaCO2 水平均高于LP组[(38±5)mmHg比(31±4)mmHg、(44±6)mmHg比(36±4)mmHg](均P<0.001).HP组T1~T5 时点分钟通气量、呼吸频率均低于LP组,PETCO2 水平均高于LP组(均P<0.05).除T3 时点外,HP组各时点rScO2、大脑中动脉平均流速均高于LP组,差异均有统计学意义(均P<0.05).Pearson相关性分析结果显示,行室间隔缺损修补术婴儿PETCO2 与PaCO2 呈正相关(P<0.001).结论 通过精准管理将PaCO2 维持在正常偏高水平,可以安全有效地减轻室间隔缺损手术婴儿的心脑损伤.
- [1]段蔚然,苏俊武,许耀强,等.先天性血管环的临床判别与外科治疗经验[J].2022,17(1).
- [2]刘健,刘爱军,李刚,等.肺血管发育不良型法洛四联症分期矫治效果分析[J].2020,(7).
- [3]Caroline C Menache,Adré J du Plessis,David L Wessel,etc.Current incidence of acute neurologic complications after open-heart operations in children[J].2002,73(6).
- [4]Aliwalas LL,Noble L,Nesbitt K,etc.Agreement of carbon dioxide levels measured by arterial, transcutaneous and end tidal methods in preterm infants < or = 28 weeks gestation.[J].2005,25(1).
- [5]Chi, Laiting,Wang, Nan,Yang, Wanchao,etc.Protection of Myocardial Ischemia-Reperfusion by Therapeutic Hypercapnia: a Mechanism Involving Improvements in Mitochondrial Biogenesis and Function[J].2019,12(5).
- [6]Makiko, Komori,Katsumi, Takada,Yasuko, Tomizawa,etc.Permissive range of hypercapnia for improved peripheral microcirculation and cardiac output in rabbits.[J].2007,35(9).
- [7]Fumikazu Nomura,Mitsuru Aoki,Joseph M. Forbess,etc.Effects of Hypercarbic Acidotic Reperfusion on Recovery of Myocardial Function After Cardioplegic Ischemia in Neonatal Lambs[J].1994,90(5).
- [8]Marin H. Kollef,Todd Wragge,Christina Pasque.Determinants of Mortality and Multiorgan Dysfunction in Cardiac Surgery Patients Requiring Prolonged Mechanical Ventilation[J].1995,107(5).
- [9]Marx G,Spillner J,Rex S,etc.The intraoperative decrease of selenium is associated with the postoperative development of multiorgan dysfunction in cardiac surgical patients.[J].2011,39(8).
- [10]Spaeder, Michael C.,Klugman, Darren,Skurow-Todd, Kami,etc.Perioperative Near-Infrared Spectroscopy Monitoring in Neonates With Congenital Heart Disease: Relationship of Cerebral Tissue Oxygenation Index Variability With Neurodevelopmental Outcome[J].2017,18(3).
- [11]Kussman BD,Wypij D,Laussen PC,etc.Relationship of intraoperative cerebral oxygen saturation to neurodevelopmental outcome and brain magnetic resonance imaging at 1 year of age in infants undergoing biventricular repair.[J].2010,122(3).
- [12]Brier MR,Xu F,Yang Y,etc.The influence of carbon dioxide on brain activity and metabolism in conscious humans.[J].2011,31(1).
- [13]SHIBATA KEIZO,CREGG NUALA,ENGELBERTS DOREEN,etc.Hypercapnic Acidosis May Attenuate Acute Lung Injury by Inhibition of Endogenous Xanthine Oxidase[J].1998.
- [14]Benallal H.,Busso T..Analysis of end-tidal and arterial PCO2 gradients using a breathing model[J].2000,83(4-5).
- [15]Peng T,Rowley AB,Ainslie PN,etc.Multivariate system identification for cerebral autoregulation.[J].2008,36(2).
- [16]Laffey JG,Kavanagh BP.Carbon dioxide and the critically ill--too little of a good thing?[J].1999,354(9186).
- [17]Bendixen H. H.,Whyte Hedley,Laver M. B..Impaired Oxygenation in Surgical Patients during General Anesthesia with Controlled Ventilation[J].1963.
- [18]Balzer Felix,Sander Michael,Simon Mark,etc.High central venous saturation after cardiac surgery is associated with increased organ failure and long-term mortality: an observational cross-sectional study[J].2015,19(1).