2022 年第 7 期 第 17 卷

室间隔缺损婴儿麻醉诱导前后脑氧饱和度和脑血流速度的变化及其相关性

Changes and correlation of regional cerebral oxygen saturation and cerebral blood flow velocity in infants with ventricular septal defect before and after anesthesia induction

作者：吕誉芳欧阳川张冬妮马骏

英文作者：Lyu Yufang Ouyang Chuan Zhang Dongni Ma Jun

单位：首都医科大学附属北京安贞医院麻醉中心，北京100029

英文单位：Anesthesia Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：室间隔缺损；脑氧饱和度；脑血流速度

英文关键词：Ventricularseptaldefect;Regionalcerebraloxygensaturation;Cerebralbloodflowvelocity

• 摘要：

• 目的 探讨室间隔缺损（VSD）婴儿麻醉诱导前后脑氧饱和度（rScO2）和脑血流速度（CBFV）的变化及其相关性。方法 本研究纳入首都医科大学附属北京安贞医院2020年9月至2021年1月1岁以内于体外循环辅助下行VSD修补术的患儿30例。使用近红外光谱监测仪（NIRS）及经颅超声多普勒（TCD）在患儿咪达唑仑和舒芬太尼静脉麻醉诱导前（T1）、插管前（T2）、插管后1 min（T3）、插管后10 min（T4）、插管后15 min（T5）、插管后20 min（T6）监测rScO2及收缩期CBFV、舒张期CBFV、平均CBFV、搏动指数和阻力指数。以上资料行不同时点比较并分析患儿rScO2与CBFV及人口统计学资料的相关性。结果 患儿T1时点rScO2显著低于T2、T3及T5、T6时点［（71±4）%比（77±6）%、（75±7）%、（73±6）%、（73±6）%］（均P＜0.05），T2时点rScO2显著高于其他各时点（均P＜0.05）。T1时点收缩期CBFV显著低于T2及T4~T6时点［（106±26）cm/s比（124±29）、（117±23）、（117±20）、（119±17）cm/s］（均P＜0.05），与T3时点差异无统计学意义（P>0.05）。T1时点舒张期CBFV、平均CBFV与其他各时点差异均无统计学意义（均P>0.05）。T1时点rScO2与收缩期CBFV、舒张期CBFV、平均CBFV无显著相关性（均P＞0.05），与月龄、体质量、身高、体表面积呈显著正相关（均P＜0.05）。T2时点rScO2与收缩期CBFV、舒张期CBFV、平均CBFV呈显著正相关（r=0.468，P=0.028；r=0.561，P=0.007；r=0.480，P=0.024），与月龄、体质量、身高、体表面积亦呈显著正相关（均P＜0.05）。结论 VSD患儿在咪达唑仑及舒芬太尼静脉麻醉诱导阶段rScO2和CBFV均未低于麻醉诱导前。咪达唑仑及舒芬太尼静脉麻醉诱导可使VSD患儿脑氧合及脑血流在诱导阶段处于正常水平。

• Objective To discuss the changes and correlation of regional cerebral oxygen saturation(rScO2) and cerebral blood flow velocity (CBFV) in infants with ventricular septal defect (VSD) before and after anesthesia induction. Methods Thirty infants were enrolled who underwent VSD repair assisted by cardiopulmonary bypass in Beijing Anzhen Hospital, Capital Medical University from September 2020 to January 2021. rScO2 before anesthesia induction(T1), before intubation(T2), 1 min after intubation(T3), 5 min after intubation(T4), 10 min after intubation(T5), and 20 min after intubation(T6), systolic CBFV, diastolic CBFV, mean CBFV, pulsatility index and resistance index were recorded by near infrared spectroscopy and transcranial Doppler. The above data lines were compared between different time points, and the correlations between rScO2, CBFV and demographic data were analyzed. Results The rScO2 in infants at T1 was significantly lower than that at T2, T3, T5, and T6［（71±4）% vs （77±6）%,（75±7）%,（73±6）%,（73±6）%］(all P<0.05), and rScO2 at T2 was significantly higher than that at other time points (all P<0.05). The systolic CBFV at T1 was significantly lower than that at T2 and T4-T6［（106±26）cm/s vs （124±29）,（117±23）,（117±20）,（119±17）cm/s］(all P<0.05), and there was no significant difference from T3（P>0.05）. There were no significant differences in diastolic CBFV and mean CBFV between T1 and other time points(all P>0.05). rScO2 at T1 had no significant correlation with systolic CBFV, diastolic CBFV and average CBFV(all P>0.05), while it had significant positive correlation with month age, body mass, height and body surface area (all P<0.05). At T2, rScO2 was significantly positively correlated with systolic CBFV, diastolic CBFV and mean CBFV(r=0.468, P=0.028; r=0.561, P=0.007; r=0.480, P=0.024), and was also significantly positively correlated with month age, body mass, height and body surface area(all P<0.05). Conclusions During the induction of intravenous anesthesia by midazolam and sufentanil in infants with VSD, rScO2 and CBFV were not lower than those before induction. Intravenous induction by midazolam and sufentanil can maintain the brain oxygenation and cerebral blood flow at normal levels in infants with VSD.