摘要
目的探讨围体外循环期间低氧分压和高氧分压对新生儿脏器功能的影响。方法收集本院2023年1月至2024年12月内住院并接受体外循环下心脏手术的新生儿患儿,按照术中动脉氧分压(PaO2)水平分为高氧分压组(Pa O2>200 mmHg)和低氧分压组(PaO2≤200 mmHg),收集患儿术前和术后次日的血总胆红素、血肌酐检查结果,收集患儿麻醉诱导后切皮前、术中、手术结束后6 h的乳酸水平,比较术前与术后及两组间各指标的差异。结果共纳入接受体外循环的新生儿60例,男41例,女19例,平均年龄(11.29±7.50)d,平均体重(3.39±0.61)kg,高氧分压组30例,低氧分压组30例。高氧分压组:总胆红素水平术后次日明显高于术前,差异有统计学意义(P<0.05);肌酐水平术后次日明显高于术前,差异有统计学意义(P<0.05);乳酸水平术中及术后6 h均高于麻醉诱导后切皮前,差异有统计学意义(P<0.05)。低氧分压组:总胆红素水平术后次日高于术前,但差异无统计学意义;肌酐水平术后次日较术前稍升高,无统计学差异;乳酸水平术中及术后6 h均高于麻醉诱导后切皮前,差异有统计学意义(P<0.05)。两组间比较发现高氧分压组术后胆红素水平及肌酐水平较低氧分压组都高,但差异无统计学意义;乳酸水平术前都在正常范围,但两组间有一些差异(P<0.05);术中及术后6 h乳酸水平高氧分压组较低氧分压组高,但差异没有统计学意义。结论高氧分压管理对新生儿心脏手术后肝肾功能及全身灌注有损害,围体外循环期间降低氧浓度,实施低氧分压管理可以改善新生儿术后肝肾功能及乳酸代谢水平。
Objective To evaluate the effect of high versus low oxygen partial pressure(PaO2)management on organ function in neonates undergoing cardiac surgery with cardiopulmonary bypass(CPB).Methods Neonates who underwent CPB-supported cardiac surgery at our institution from January 2023 to December 2024 were stratified into two groups:a high-PaO2 group(PaO2>200 mmHg)and a low-PaO2 group(PaO2≤200 mmHg).Preoperative and postoperative serum total bilirubin,creatinine,and serial lactate levels(pre-incision,intraoperative,and 6 hours post-CPB)were analyzed.Organ dysfunction and perfusion status were compared between groups.Results Sixty neonates(male:41;female:19;mean age:11.29±7.50 days;mean weight:3.39±0.61 kg)were included,with 30 patients in each group.High-PaO2 group:Postoperative total bilirubin and creatinine levels increased significantly compared to preoperative baselines(P<0.05).Intraoperative and 6-hour postoperative lactate levels were elevated versus pre-incision values(P<0.05).Low-PaO2 group:Postoperative bilirubin and creatinine level showed non-significant increases.Lactate levels rose intraoperatively and at 6 hours postoperatively(P<0.05).Intergroup comparisons revealed higher postoperative bilirubin and creatinine in the high-PaO2 group,though differences were non-significant.Intraoperative and 6-hour lactate levels trended higher in the high-PaO2 group.Conclusion High PaO2 management during neonatal CPB is associated with aggravated postoperative hepatic/renal dysfunction and impaired systemic perfusion.Restrictive oxygen strategies(PaO2≤200 mmHg)may mitigate organ injury and improve lactate clearance.
作者
张晓娟
缪娜
汪晓楠
林霖
杨晓芳
王佳露
樊星
赵举
Zhang Xiaojuan;Miao Na;Wang Xiaonan;Lin Lin;Yang Xiaofang;Wang Jialu;Fan Xing;Zhao Ju(Department of Cardiopulmonary Bypass and Mechanical Circulatory Support,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)
出处
《中国体外循环杂志》
2025年第4期307-310,共4页
Chinese Journal of Extracorporeal Circulation
关键词
新生儿
体外循环
高氧分压
肾损伤
肝损伤
Neonatal
Cardiopulmonary bypass
Hyperoxia
kidney injury
Hepatic dysfunction
