先天性心脏病和慢性低氧血症儿童的大脑血氧饱和度
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Cerebral Oxygen Saturation in Children With Congenital Heart Disease and Chronic Hypoxemia
背景与目的
伴随低氧血症的血红蛋白（Hb）浓度增加是维持组织氧输送的补偿性反应。 临床上使用近红外光谱（NIRS）来检测脑组织氧输送和消耗的平衡异常，包括先天性心脏病（CHD）的儿童。 虽然近红外光谱测量的脑组织血氧饱和度（ScO2）与动脉血氧饱和度（SaO2）相关，颈静脉球血氧饱和度（SjbO2）和Hb，这些因素与脑O2提取（COE）之间的相互作用几乎没有数据。 本研究调查了脑血氧饱和度和动脉-脑血氧饱和度之差与动脉血氧饱和度和血红蛋白的关系，并验证先心
病儿童脑血氧饱和度的正常范围。
方 法
校准和FORE-SIGHT近红外光谱监视器的验证研究纳入了进行先心病心脏导管插入术的儿童。 绘制两对同时动脉和颈静脉球样品的一氧化碳氧饱和度，计算相关脑血氧饱和度（REF CX）和评估脑氧提取。 使用皮尔森相关和线性回归来确定氧饱和度参数和血红蛋白之间的关系。 根据诊断组（定义SaO2≥90％为非发绀和SaO2 <90％为发绀）进行数据分析。
结 果
研究了65名儿童，可接受的颈静脉球样本（SjbO2绝对差异样本≤10％）为57（88％）。 动脉-颈动脉球血氧饱和度之差，动脉-脑血氧饱和度之差和 动脉-相关脑血氧饱和度之差与动脉血氧饱和度呈正相关，与血红蛋白呈负相关（全P <0.001）。 虽然诊断组脑血氧饱和度差异有统计学意义（P = .002），但是，发绀患者的值在正常范围内（69％±6％）。 通过动脉和颈静脉球氧含量不同来评估脑氧的提取（ΔCaO2-CjbO2，mL O2 / 100mL）在发绀和非发绀患者没有差异（P = 0.10），但是使用动脉-颈动脉球血氧饱和度之差，动脉-脑血氧饱和度之差和 动脉-相关脑血氧饱和度之差，发绀和非发绀患者有统计学意义（P <0.001）。
结 论
充分代偿的慢性低氧血症儿童似乎脑血氧饱和度值在正常范围内。 动脉-脑血氧饱和度之差与血红蛋白呈负相关，这意味着在存在Hb降低的情况下，特别是与心输出量减少相结合时，脑血氧饱和度可能下降到与实验室研究中的脑损伤相关的值。
原始文献摘要
Barry D. Kussman, MBBCh, FFA(SA),* Peter C. Laussen, et al. Cerebral Oxygen Saturation in Children With Congenital Heart Disease and Chronic Hypoxemia.[J]. Anesth Analg 2017;125:234–40
BACKGROUND: Increased hemoglobin (Hb) concentration accompanying hypoxemia is a compensatory response to maintain tissue oxygen delivery. Near infrared spectroscopy (NIRS) is used clinically to detect abnormalities in the balance of cerebral tissue oxygen delivery and consumption,including in children with congenital heart disease (CHD). Although NIRS-measured cerebral tissue O2 saturation (ScO2) correlates with arterial oxygen saturation (SaO2), jugular
bulb O2 saturation (SjbO2), and Hb, little data exist on the interplay between these factors and cerebral O2 extraction (COE). This study investigated the associations of ScO2 and ΔSaO2−ScO2 with SaO2 and Hb and verified the normal range of ScO2 in children with CHD.
METHODS: Children undergoing cardiac catheterization for CHD were enrolled in a calibration and validation study of the FORE-SIGHT NIRS monitor. Two pairs of simultaneous arterial and jugular bulb samples were drawn for co-oximetry, calculation of a reference ScO2 (REF CX), and estimation of COE. Pearson correlation and linear regression were used to determine relationships between O2 saturation parameters and Hb. Data were also analyzed according to diagnostic group defined as acyanotic (SaO2 ≥ 90%) and cyanotic (SaO2 < 90%).
RESULTS: Of 65 children studied, acceptable jugular bulb samples (SjbO2 absolute difference between samples ≤10%) were obtained in 57 (88%). The ΔSaO2−SjbO2, ΔSaO2−ScO2, and ΔSaO2−REF CX were positively correlated with SaO2 and negatively correlated with Hb (all P < .001). Although by diagnostic group ScO2 differed statistically (P = .002), values in the cyanotic patients were within the range considered normal (69% ± 6%). COE estimated by the difference between arterial and jugular bulb O2 content (ΔCaO2−CjbO2, mL O2/100 mL) was not different for cyanotic and acyanotic patients (P = .10), but estimates using ΔSaO2−SjbO2, ΔSaO2−ScO2, or ΔSaO2−ScO2/SaO2 were significantly different between the cyanotic and acyanotic children (P < .001).
CONCLUSIONS: Children with adequately compensated chronic hypoxemia appear to have ScO2 values within the normal range. The ΔSaO2−ScO2 is inversely related to Hb, with the implication that in the presence of reduced Hb, particularly if coupled with a decreased cardiac output, the ScO2 can fall to values associated with brain injury in laboratory studies. (Anesth Analg 2017;125:234–40)
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