Qiang Zhipeng,Zhang Jianmin,Zhao Xin,et al.Effect of postural changes on regional cerebral oxygen saturation in children during scoliosis correction surgery[J].Journal of Clinical Pediatric Surgery,2020,19(02):125-129,154.[doi:10.3969/j.issn.1671-6353.2020.02.007]
儿童脊柱侧弯手术中体位改变对患儿脑氧饱和度的影响分析
- Title:
- Effect of postural changes on regional cerebral oxygen saturation in children during scoliosis correction surgery
- Keywords:
- Scoliosis; Regional Cerebral Oxygen Saturation; Posture; Child
- 分类号:
- R726.8;R682.3;R443+.9
- 摘要:
- 目的 探讨儿童脊柱侧弯手术中体位改变对患儿局部脑氧饱和度（regional cerebral oxygen saturation，rScO2）的影响，旨在提高麻醉和手术的安全性。方法 选择年龄3~14岁择期全麻下行脊柱侧弯矫正术的患儿44例，男童23例，女童21例，ASA分级Ⅰ~Ⅲ级。患儿入室后，采用近红外光谱（near-infrared spectroscopy，NIRS）持续监测双侧rScO2，记录患儿吸纯氧前（T0，基线）、麻醉诱导插管后（T1）、俯卧位前5 min（T2）、俯卧位后5 min（T3）、俯卧位后15 min（T4）、俯卧位后30 min（T5）、俯卧位后45 min（T6）、俯卧位后60 min（T7）、俯卧位后75 min（T8）、俯卧位后90 min（T9）、俯卧位后105 min（T10）、俯卧位后120 min（T11）双侧rScO2值。桡动脉穿刺后持续记录有创动脉压（invasive arterial blood pressure，IABP）、心率（Heart Rate，HR）、脉搏血氧饱和度（pulse oxygen saturation，SpO2）和呼气末二氧化碳分压（end tidal carbon dioxide partial pressure，PetCO2）。结果 患儿由仰卧位转为俯卧位后的每一观察时点左右两侧脑氧饱和度值均低于仰卧位水平（P<0.01），俯卧位后2 h内，左侧rScO2由翻身前的81.30%下降至74.05%，右侧rScO2由翻身前的81.52%下降至73.86%。MAP在T3、T4、T5、T6和T7 5个观察时间点与T2相比无明显差异（P>0.05），T8、T9、T10和T11四个时间点与T2相比有明显降低（P<0.05）；患儿HR、SpO2及PetCO2在T3~T11九个观察时间点与T2时间点相比均无明显差异（P>0.05）。结论 俯卧位会使患儿rScO2降低，因此应尽量缩短患儿俯卧位时间，加强术中患儿脑保护，保证手术安全。
- Abstract:
- Objective To evaluate the effect of postural changes in children with scoliosis correction on regional cerebral oxygen saturation.Methods A total of 44 children undergoing selective scoliosis correction under general anesthesia were recruited.There were 23 boys and 21 girls with an age range of (3-14) years.The ASA grades were Ⅰ-Ⅲ.Continuous monitoring of bilateral regional cerebral oxygen saturation was performed by near-infrared spectroscopy (NIRS) after room entry.The value of rScO2 was recorded before pure oxygen inhalation (T0,baseline),after anesthesia induced intubation (T1),5 min before prone position (T2),5 min after prone position (T3),15 min after prone position (T4),30 min after prone position (T5),45minutes after prone position (T6),60 minutes after prone position (T7),75 min after prone position (T8),90 min after prone position(T9),105 min after prone position (T10) and 120 min after prone position (T11).Arterial blood pressure (ABP),heart rate (HR),pulse oxygen saturation (SpO2) and end tidal carbon dioxide partial pressure (PetCO2) were continuously recorded after radial artery puncture.Results The values of rScO2 of left/right side were lower than those of supine position at each timepoint after prone position.And rScO2 decreased from 81.30% to 74.05% at left side and dropped from 81.52% to 73.86% at right side after 2h of prone position.No significant difference existed in MAP between T3,T4,T5,T6,T7 and T2 (P>0.05).However,significant decreases occurred in T8,T9,T10 and T11 (P<0.05); No significant difference existed in HR,SpO2or PetCO2 between T3-T11 and T2 (P>0.05).Postural changes affected regional cerebral oxygen saturation in children.Within 2 hours from supine to prone position,rScO2 was lower than supine position (P<0.01).Conclusion Regional cerebral oxygen saturation decreases in prone position.Therefore intraoperative prone position should be minimized as much as possible and brain protection should be strengthened for enhancing surgical safety.
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备注/Memo
收稿日期:2019-09-14。
通讯作者:张建敏,Email:zjm428@sina.com