中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

近红外光谱仪预测肺动脉闭锁术前不良事件

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目的 评估近红外光谱仪监测区域组织血氧饱和度对于早期预测肺动脉闭锁术前患儿不良事件的可能性。 方法 2016 年 1 月至 2017 年 5 月入住我院心脏重症监护病房,诊断为肺动脉闭锁年龄<3 个月的小婴儿 26 例,其中男 19 例、女 7 例,年龄 2~89 d,接受近红外光谱仪监测区域组织(脑组织和和腹部内脏组织)血氧饱和度。分析患儿 625 次心率、血压、指脉氧、区域组织血氧饱和度和 98 个乳酸指标,探索区域组织血氧饱和度变化与临床不良事件的关系。 结果 常规监测发现不良事件 69 次(11.04%):27 次单纯血氧饱和度降低,16 次血氧饱和度降低合并乳酸增高,6 次单纯低血压,17 次低血压合并乳酸增高,3 次单纯乳酸增高。脑组织血氧饱和度降低 12.80% 预示不良事件可能性高,敏感度 85.30%,特异度 87.00%。腹部内脏组织血氧饱和度降低 20.60% 预示不良事件可能性高,敏感度 73.50%,特异度 91.20%。发现低血压前 3 min 及乳酸增高前 45 min 内脏组织血氧饱和度已经降低。 结论 对于肺动脉闭锁术前患儿,脑组织血氧饱和度降低 12.80% 或内脏组织血氧饱和度降低 20.60% 需要引起临床医师警觉。

Objective To evaluate the possibility of monitoring regional tissue oxygen saturation by near-infrared spectroscopy (NIRS) for early predicting adverse events in patients with pulmonary atresia. Methods Twenty-six patients aged under 3 months who were diagnosed with pulmonary atresia and admitted to cardiovascular intensive care unit in our hospital between January 2016 and May 2017, accepted regional tissue oxygenation (cerebral and splanchnic) by near-infrared spectroscopy. There were 19 males and 7 females at age of 2–89 days. A total of 625 times of heart rate, blood pressure, pulse saturation, regional tissue oxygenation, and 98 serum lactate were retrospectively analyzed. The relationship of the tissue oxygen saturation and clinical adverse events was explored. Results The adverse event by routine monitoring was 69 (11.04%) person-time: isolated hypoxia in 27, hypoxia combined increased lactate in 16, hypotension in 6, hypotension combined increased lactate in 17, isolated increased lactate in 3. A reduction of 12.80% in cranial oxygen predicted the high probability of adverse events, with a sensitivity of 85.30% and a specificity of 87.00%. A reduction of 20.60% in splanchnic oxygen predicted the high probability of adverse event, with a sensitivity of 73.50% and a specificity of 91.2%. On average, the splanchnic oxygenation had fell 3 minutes before a reduction of blood pressure, or 45 minutes before an increase in lactate. Conclusion For preoperative patients with pulmonary atresia, a fall of 12.80% in cranial oxygen saturations, or of 20.60% in splanchnic oxygen saturation, should attract clinician’s awareness.

关键词: 近红外光谱仪; 区域组织血氧饱和度; 先天性心脏病; 肺动脉闭锁

Key words: Near-infrared spectroscopy; regional tissue oxygen saturation; congenital heart disease; pulmonary atresia

引用本文: 黄继红, 张明杰, 柳立平, 徐卓明. 近红外光谱仪预测肺动脉闭锁术前不良事件. 中国胸心血管外科临床杂志, 2018, 25(4): 273-277. doi: 10.7507/1007-4848.201709020 复制

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