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目的 :为减少心脏手术后中枢神经系统并发症 ,探讨术中采用连续监测脑氧饱和度 (rSO2 )的临床意义。方法 :选择 2个月～ 3岁心脏病患儿 81例 ,分为紫绀组 (36例 )和非紫绀组 (45例 )。采用芬太尼 -安氟醚静吸复合麻醉 ,体外循环用非搏动平流灌注 ,流量 1 0 0～ 1 50mL/kg。用脑氧饱和度仪测量rSO2 ,分别于全麻诱导、主动脉插管、阻断升主动脉、阻断升主动脉后 1 5min、开放升主动脉、停机及手术结束等时点记录rSO2 、平均动脉压、鼻温及肛温等变化。结果 :麻醉诱导时rSO2 平均值 46 33 % ,紫绀组rSO2 明显低于非紫绀组 ;降温阶段 ,rSO2 显著升高 ,而复温开始后rSO2 降低 ,开放升主动脉时达手术过程中最低值 (40 69% )。结论 :rSO2 能较准确反映此类手术中脑氧合状态。降温阶段rSO2 较高 ,不宜过度灌注 ;复温阶段特别是在开放升主动脉时 ,rSO2 较低 ,故应避免复温过快 ,并适时增加流量 ,适当提高脑灌注压
Objective: To explore the clinical significance of continuous monitoring of cerebral oxygen saturation (rSO2) during operation to reduce central nervous system complications after cardiac surgery. Methods: 81 children aged 2 months to 3 years with heart disease were divided into three groups: cyanotic group (36 cases) and non-cyanotic group (45 cases). Fentanyl - enflurane inhalation combined anesthesia, cardiopulmonary bypass with non-beating advection perfusion, flow rate of 100 ~ 150mL / kg. RSO2 was measured by cerebral oxygen saturation meter, and rSO2 was recorded at different time points, such as induction of general anesthesia, aortic cannulation, occlusion of the ascending aorta, blocking of the ascending aorta 15 min after opening, ascending aorta, Mean arterial pressure, nasal temperature and rectal temperature and other changes. Results: The average value of rSO2 was 46.33% when anesthesia was induced and the rSO2 in cyanotic group was significantly lower than that in non-cyanotic group. The rSO2 was significantly increased in the cooling stage and rSO2 was decreased after the rewarming started, 40 69%). Conclusion: rSO2 can accurately reflect the state of cerebral oxygenation in these operations. Cooling stage rSO2 higher should not be over-perfusion; rewarming stage especially in the open ascending aorta, rSO2 lower, it should avoid rewarming too fast, and timely increase in flow, and appropriate increase cerebral perfusion pressure