Objective: To study the effect of blood transfusion therapy on oxygen saturation in brain and intestinal tissues of children with premature anaemia. Methods: Ninety-five children with premature anaemia in our hospital...Objective: To study the effect of blood transfusion therapy on oxygen saturation in brain and intestinal tissues of children with premature anaemia. Methods: Ninety-five children with premature anaemia in our hospital from August 2016 to July 2018 were selected and divided into three groups according to the different degrees of anemia, namely, mild group (n=30), moderate group (n=30) and severe group (n=35), meanwhile, another 35 premature without anemia were set as control group. Then the basal vital signs, levels of hemoglobin (Hb) and hematocrit (Hct), as well as the oxygen saturation in brain and intestinal tissue were compared among the four groups. Results: The SBP and DBP between the four groups after treatment had no difference. The HR and RR after treatment in the control group and the mild group were significantly higher than those in the severe group. The RR of the mild group was significantly lower than that of the control group, with statistical difference. The Hb in the control group and the mild group was significantly higher than that in the moderate group and the severe group. The Hb in the moderate group was significantly higher than that in the severe group. Hct in the control group and the mild group was significantly higher than that in the severe group. The Hct in the moderate group had no statistic difference with that of the mild group and severe group. The cerebral oxygen saturation after treatment in the control group and the mild group was significantly higher than that in the severe group, meanwhile the intestinal tissue oxygen saturation after treatment of the control group was significantly higher than that in the severe group. Cerebral oxygen saturation after treatment showed no difference between the severe group and the moderate group, and the intestinal tissue oxygen saturation after treatment either had no difference among the severe group, the moderate group and the mild group. Conclusion: Blood transfusion therapy can significantly improve the oxygen saturation of brain and intestinal tissues in children with premature anaemia without affecting blood pressure, and improve the degree of anemia, which can be used reasonably under the strict control of clinical indications.展开更多
Objective: To assess the effects of various anesthetic techniques and PaCO2 levels on cerebral oxygen supply/consumption balance during craniotomy for removal of tumors, and to explore an anesthetic technique for neur...Objective: To assess the effects of various anesthetic techniques and PaCO2 levels on cerebral oxygen supply/consumption balance during craniotomy for removal of tumors, and to explore an anesthetic technique for neurosur-gery and an appropriate degree of PaCO2 during neuroanesthesia. Methods: One hundred and fourteen patients with supratentorial tumors for elective craniotomy, ASA grade I - II , were randomly allocated to six groups. Patients were anesthetized with continuous intravenous infusion of 2% procaine 1. 0 mg · kg-1 · min-1 in Group I , inhalation of 1. 0% - 1. 5% isoflurane in Group II , and infusion of 2% procaine 0. 5 mg·kg · min-1 combined with inhalation of 0.5% -0.7% isoflurane in Group III during the period of study. The end-tidal pressure of CO2(PET CO2 ) was maintained at 4.0 kPa in these 3 groups. In Group IV, V and VI, the anesthetic technique was the same as that in Group I but the PETCO2 was adjusted to 3. 5, 4. 0 and 4. 5 kPa respectively for 60 min during which the study was performed. The radial arterial and retrograde jugular venous blood samples were obtained at the onset and the end of this study for determining jugular venous bulb oxygen saturation ( SjvO2 ) , arteriovenous oxygen content difference (AVDO2) and cerebral extraction of oxygen (CEO2). Results: In Group I and I SjvO2, AVDO2 and CEO2 remained stable. Although SjvO2 kept constant, AVDO2 and CEO2 decreased significantly (P <0. 05) in Group II. Moreover, AVDO2 and CEO2 in Group II were significantly lower than those of Group III (P<0. 05). In Group IV, 60 min after hyperventilation, SjvO2 and jugular venous oxygen content ( CjvO2 ) decreased markedly (P < 0. 01 ) while CEO2 increased significantly ( P <0.01) . In addition, SjvO2, CjvO2 and CEO2 in Group IV were significantly different from the corresponding parameters in Group V and Group VI (P <0. 05) . In view of sustained excessive hyperventilation, SjvO2 was less than 50% in 37.5% patients of Group IV. Conclusion: Anesthesia with intravenous infusion of procaine combined with isoflurane inhalation proved to be more suitable for neurosurgery than procaine intravenous anesthesia or isoflurane inhalation anesthesia alone. PaCO2 at 4.0 -4. 5 kPa in patients undergoing craniocerebral surgery during neuroanesthesia would be beneficial in both decreasing ICP and maintaining cerebral oxygen supply/consumption balance.展开更多
Regional oxygen saturation (rSO2) is a new method to evaluate regional oxygen supply and demand balance by near-infrared spectroscopy. It has the advantages of noninvasive, continuous and sensitive, and has been succe...Regional oxygen saturation (rSO2) is a new method to evaluate regional oxygen supply and demand balance by near-infrared spectroscopy. It has the advantages of noninvasive, continuous and sensitive, and has been successfully applied in clinical guidance. Regional oxygen saturation is usually referred to as regional cerebral oxygen saturation (rScO2) and regional tissue oxygen saturation (rStO2) depending on the site of monitoring. Initially, cerebral oxygen saturation monitoring has been used in cardiothoracic surgery and in non-cardiac surgery for elderly and critically ill patients. With the increase of clinical application, regional oxygen saturation is gradually extended to the determination of oxygen saturation in peripheral tissues, which is used to evaluate the relationship between peripheral tissue microcirculation function and the prognosis of patients. Timely detection of tissue ischemia and hypoxia and intervention can optimize the whole clinical treatment management, especially for major surgery and critically ill patients can reduce the incidence of complications during hospitalization, shorten hospitalization time, improve the prognosis of patients. This article will focus on the clinical application of cerebral oxygen saturation and tissue oxygen saturation in perioperative period.展开更多
目的观察和比较局部脑氧饱和度(SctO2)和躯体氧饱和度(SstO2)在患儿主动脉弓部手术中的变化。方法收集2015年1月至2017年2月收治的主动脉弓缩窄(coarctation of aorta,COA)或主动脉弓离断(interruption of aortic arch,IAA)合并心内畸形...目的观察和比较局部脑氧饱和度(SctO2)和躯体氧饱和度(SstO2)在患儿主动脉弓部手术中的变化。方法收集2015年1月至2017年2月收治的主动脉弓缩窄(coarctation of aorta,COA)或主动脉弓离断(interruption of aortic arch,IAA)合并心内畸形,择期在心肺转流(cardiopulmonary bypass,CPB)联合选择性脑灌注(selective cerebral perfusion,SCP)下行一期矫治术的患儿21例,男16例,女5例,年龄12 d至11个月,体重3~6 kg ASA Ⅲ或Ⅳ级。采用全身麻醉和常规监测,同时持续监测右额部和背部局部组织氧饱和度,分别为SctO2和SstO2。于诱导时(T0)、切皮时(T1)、CPB开始(T2)、SCP开始(T3)、停SCP(T4)、主动脉开放(T5)、停CPB(T6)、术毕(T7)时记录SctO2、SstO2、中心静脉氧饱和度(ScvO2)。结果与T0时比较,T2、T5、T6时SctO2明显降低(P<0.05)。T0—T4时SctO2明显高于SstO2(P<0.05);T5—T7时SctO2明显低于SstO2(P<0.05)。SctO2与ScvO2的Pearson相关系数r=0.80(P<0.05)。结论在患儿主动脉弓部手术中,SctO2和SstO2差异和变化较大,可以依据其变化趋势,指导术中精细化调控。展开更多
文摘Objective: To study the effect of blood transfusion therapy on oxygen saturation in brain and intestinal tissues of children with premature anaemia. Methods: Ninety-five children with premature anaemia in our hospital from August 2016 to July 2018 were selected and divided into three groups according to the different degrees of anemia, namely, mild group (n=30), moderate group (n=30) and severe group (n=35), meanwhile, another 35 premature without anemia were set as control group. Then the basal vital signs, levels of hemoglobin (Hb) and hematocrit (Hct), as well as the oxygen saturation in brain and intestinal tissue were compared among the four groups. Results: The SBP and DBP between the four groups after treatment had no difference. The HR and RR after treatment in the control group and the mild group were significantly higher than those in the severe group. The RR of the mild group was significantly lower than that of the control group, with statistical difference. The Hb in the control group and the mild group was significantly higher than that in the moderate group and the severe group. The Hb in the moderate group was significantly higher than that in the severe group. Hct in the control group and the mild group was significantly higher than that in the severe group. The Hct in the moderate group had no statistic difference with that of the mild group and severe group. The cerebral oxygen saturation after treatment in the control group and the mild group was significantly higher than that in the severe group, meanwhile the intestinal tissue oxygen saturation after treatment of the control group was significantly higher than that in the severe group. Cerebral oxygen saturation after treatment showed no difference between the severe group and the moderate group, and the intestinal tissue oxygen saturation after treatment either had no difference among the severe group, the moderate group and the mild group. Conclusion: Blood transfusion therapy can significantly improve the oxygen saturation of brain and intestinal tissues in children with premature anaemia without affecting blood pressure, and improve the degree of anemia, which can be used reasonably under the strict control of clinical indications.
基金Supported by the"Tenth five-year-plan"Medical Science Foundation of PLA(NO.01M118 to Dr.CHEN).
文摘Objective: To assess the effects of various anesthetic techniques and PaCO2 levels on cerebral oxygen supply/consumption balance during craniotomy for removal of tumors, and to explore an anesthetic technique for neurosur-gery and an appropriate degree of PaCO2 during neuroanesthesia. Methods: One hundred and fourteen patients with supratentorial tumors for elective craniotomy, ASA grade I - II , were randomly allocated to six groups. Patients were anesthetized with continuous intravenous infusion of 2% procaine 1. 0 mg · kg-1 · min-1 in Group I , inhalation of 1. 0% - 1. 5% isoflurane in Group II , and infusion of 2% procaine 0. 5 mg·kg · min-1 combined with inhalation of 0.5% -0.7% isoflurane in Group III during the period of study. The end-tidal pressure of CO2(PET CO2 ) was maintained at 4.0 kPa in these 3 groups. In Group IV, V and VI, the anesthetic technique was the same as that in Group I but the PETCO2 was adjusted to 3. 5, 4. 0 and 4. 5 kPa respectively for 60 min during which the study was performed. The radial arterial and retrograde jugular venous blood samples were obtained at the onset and the end of this study for determining jugular venous bulb oxygen saturation ( SjvO2 ) , arteriovenous oxygen content difference (AVDO2) and cerebral extraction of oxygen (CEO2). Results: In Group I and I SjvO2, AVDO2 and CEO2 remained stable. Although SjvO2 kept constant, AVDO2 and CEO2 decreased significantly (P <0. 05) in Group II. Moreover, AVDO2 and CEO2 in Group II were significantly lower than those of Group III (P<0. 05). In Group IV, 60 min after hyperventilation, SjvO2 and jugular venous oxygen content ( CjvO2 ) decreased markedly (P < 0. 01 ) while CEO2 increased significantly ( P <0.01) . In addition, SjvO2, CjvO2 and CEO2 in Group IV were significantly different from the corresponding parameters in Group V and Group VI (P <0. 05) . In view of sustained excessive hyperventilation, SjvO2 was less than 50% in 37.5% patients of Group IV. Conclusion: Anesthesia with intravenous infusion of procaine combined with isoflurane inhalation proved to be more suitable for neurosurgery than procaine intravenous anesthesia or isoflurane inhalation anesthesia alone. PaCO2 at 4.0 -4. 5 kPa in patients undergoing craniocerebral surgery during neuroanesthesia would be beneficial in both decreasing ICP and maintaining cerebral oxygen supply/consumption balance.
文摘Regional oxygen saturation (rSO2) is a new method to evaluate regional oxygen supply and demand balance by near-infrared spectroscopy. It has the advantages of noninvasive, continuous and sensitive, and has been successfully applied in clinical guidance. Regional oxygen saturation is usually referred to as regional cerebral oxygen saturation (rScO2) and regional tissue oxygen saturation (rStO2) depending on the site of monitoring. Initially, cerebral oxygen saturation monitoring has been used in cardiothoracic surgery and in non-cardiac surgery for elderly and critically ill patients. With the increase of clinical application, regional oxygen saturation is gradually extended to the determination of oxygen saturation in peripheral tissues, which is used to evaluate the relationship between peripheral tissue microcirculation function and the prognosis of patients. Timely detection of tissue ischemia and hypoxia and intervention can optimize the whole clinical treatment management, especially for major surgery and critically ill patients can reduce the incidence of complications during hospitalization, shorten hospitalization time, improve the prognosis of patients. This article will focus on the clinical application of cerebral oxygen saturation and tissue oxygen saturation in perioperative period.
文摘目的探讨半坐位开颅患者无创脑氧饱和度(cerebral tissue oxygen saturation,SctO_(2))与颈静脉球部氧饱和度(jugular venous oxygen saturation,SjvO_(2))的影响因素。方法选取2018年4月至2020年5月首都医科大学宣武医院行半坐位听神经瘤手术的患者30例。采用Fore-sight近红外光仪监测无创SctO_(2),通过术侧颈静脉球部置管采集血液标本测定SjvO_(2)。记录半坐位切皮(T0)、硬脑膜剪开后30 min(T1)及肿瘤切除后(T2)双侧无创SctO_(2)及术侧SjvO_(2)、MAP、中心静脉压(central venous pressure,CVP)和颈静脉球部压力(jugular bulb pressure,JBP)。同时采集动脉血测定PaCO_(2)、PaO_(2),采集颈静脉球部血液标本测定颈静脉球部二氧化碳分压(pressure of carbon dioxide in the jugular venous,PjvCO_(2))、颈静脉球部氧分压(pressure of oxygen in the jugular venous,PjvO_(2))、红细胞比容(hematocrit,Hct)及乳酸(lactic acid,Lac),纳入MAP、CVP、JBP、PaCO_(2)、PaO_(2),PjvCO_(2)、PjvO_(2)、Hct及Lac进行SctO_(2)与SjvO_(2)影响因素的多元线性回归分析。结果PjvO_(2)、PjvCO_(2)、PaCO_(2)、JBP和Hct对SjvO_(2)的影响有统计学意义(P<0.05),调整后的R2=0.845;CVP、MAP及PaCO_(2)对术侧SctO_(2)的影响有统计学意义(P=0.000),调整后的R2=0.371。结论半坐位开颅患者采用SctO_(2)和SjvO_(2)监测时需考虑不同的影响因素,采取相应措施有效改善脑氧供需平衡状态。
文摘目的观察和比较局部脑氧饱和度(SctO2)和躯体氧饱和度(SstO2)在患儿主动脉弓部手术中的变化。方法收集2015年1月至2017年2月收治的主动脉弓缩窄(coarctation of aorta,COA)或主动脉弓离断(interruption of aortic arch,IAA)合并心内畸形,择期在心肺转流(cardiopulmonary bypass,CPB)联合选择性脑灌注(selective cerebral perfusion,SCP)下行一期矫治术的患儿21例,男16例,女5例,年龄12 d至11个月,体重3~6 kg ASA Ⅲ或Ⅳ级。采用全身麻醉和常规监测,同时持续监测右额部和背部局部组织氧饱和度,分别为SctO2和SstO2。于诱导时(T0)、切皮时(T1)、CPB开始(T2)、SCP开始(T3)、停SCP(T4)、主动脉开放(T5)、停CPB(T6)、术毕(T7)时记录SctO2、SstO2、中心静脉氧饱和度(ScvO2)。结果与T0时比较,T2、T5、T6时SctO2明显降低(P<0.05)。T0—T4时SctO2明显高于SstO2(P<0.05);T5—T7时SctO2明显低于SstO2(P<0.05)。SctO2与ScvO2的Pearson相关系数r=0.80(P<0.05)。结论在患儿主动脉弓部手术中,SctO2和SstO2差异和变化较大,可以依据其变化趋势,指导术中精细化调控。
