Systemic haemodynamics and regional tissue oxygen saturation after bidirectional cavopulmonary shunt: positive pressure ventilation versus spontaneous breathing
Systemic haemodynamics and regional tissue oxygen saturation after bidirectional cavopulmonary shunt: positive pressure ventilation versus spontaneous breathing
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DOI：
10.1093/icvts/ivw126
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发表时间：
2016-08-01
影响因子：
--
通讯作者：
Zhu, Deming
中科院分区：
文献类型：
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作者：
Huang, Jihong;Zhou, Yanping;Zhu, Deming
目的：自发呼吸已被证明可以改善双向腔隙肺分流术患者的整体血流动力学。然而，尚未评估的是自主呼吸对双向腔室肺分流术后心输出量分布的影响。我们研究了拔管对全身血流动力学和局部组织氧饱和度的影响，并确定这些患者拔管后心输出量是否存在重新分布。方法：对24例行双向腔室肺分流术的患者，连续监测心率、动脉血压、中心静脉压等标准血流动力学指标。每小时监测并记录大脑和肠系膜循环的近红外光谱。拔管前30 min、拔管后30 min、拔管后12 h三个时间点超声测量升主动脉血流指数。结果：中心静脉压由拔管前的19.50 +/- 3.65 mmHg降至拔管后30 min的16.17 +/- 3.41 mmHg (P = 0.006)，拔管后12 h的13.96 +/- 2.49 mmHg （P = 0.001）。拔管前心脏指数为3.32 +/- 0.43 l/min/m(2)，拔管后30 min为3.73 +/- 0.51 l/min/m(2) (P = 0.012)，拔管后12 h为3.98 +/- 0.54 l/min/m(2) （P = 0.001）。脑氧饱和度由拔管前的50.83 +/- 5.84%上升至拔管后30 min的56.79 +/- 8.64% (P = 0.023)，此后12 h保持不变。拔管初期肠系膜氧饱和度基本不变，拔管后12 h明显升高（P = 0.002）。结论：拔管前脑氧饱和度较低提示脑血流不理想。拔管初期，尽管心脏指数升高，但肠系膜氧饱和度低于拔管后12 h，说明呼吸肌灌注的强制性增加和脑氧饱和度的增加已经利用了心脏指数升高带来的大部分流量。拔管12 h后肠系膜氧饱和度升高提示微循环和大循环逐渐改善。
OBJECTIVES: Spontaneous breathing has been shown to improve global haemodynamics in patients with bidirectional cavopulmonary shunt. What has not been evaluated, however, is the effect of spontaneous breathing on the distribution of cardiac output after bidirectional cavopulmonary shunt. We investigated the effects of extubation on systemic haemodynamics and regional tissue oxygen saturation, and determined whether redistribution of cardiac output is present after extubation in these patients.METHODS: In 24 patients undergoing bidirectional cavopulmonary shunt, standard haemodynamic variables including heart rate, arterial blood pressure and central venous pressure were monitored continuously. Near-infrared spectroscopy of the brain and mesenteric circulation was monitored and recorded every hour. Cardiac index, derived from ascending aorta flow, was measured by ultrasound at three time points: 30 min before, 30 min after and 12 h after extubation.RESULTS: The central venous pressure decreased significantly from 19.50 +/- 3.65 mmHg before extubation to 16.17 +/- 3.41 mmHg 30 min after extubation (P = 0.006) and 13.96 +/- 2.49 mmHg 12 h after extubation (P = 0.001). Cardiac index increased significantly from 3.32 +/- 0.43 l/min/m(2) before extubation to 3.73 +/- 0.51 l/min/m(2) 30 min after extubation (P = 0.012) and 3.98 +/- 0.54 l/min/m(2) 12 h after extubation (P = 0.001). Cerebral oxygen saturation increased from 50.83 +/- 5.84% before extubation to 56.79 +/- 8.64% 30 min after extubation (P = 0.023), then remained unchanged for the following 12 h. Mesenteric oxygen saturation remained unchanged during the early period of extubation, but increased significantly 12 h after extubation (P = 0.002).CONCLUSIONS: The lower values of cerebral oxygen saturation before extubation indicated that the cerebral blood flow was less satisfactory. During the early period of extubation, despite the increase in cardiac index, the mesenteric oxygen saturation is lower than that at 12 h after extubation, suggesting that the obligatory increase in respiratory muscle perfusion and the increase in cerebral oxygen saturation have utilized most of the flow from the increased cardiac index. The increase in mesenteric oxygen saturation 12 h after extubation suggests a gradual improvement in microcirculation and macrocirculation.