Relatonship of Arterial Oxygen partial Pressure with Brain Injury During Cardioulonmary Bypass in Finfant with Caynotic Cogential Heart Dises
|Keywords||Cyanotic congenital heart disease CPB PaO Brain Injury Infants|
Aim of the present study by controlling cyanotic congenital heart disease (CHD) infant cardiopulmonary bypass surgery (CPB) during the arterial oxygen tension (PaO 2 ) at different levels, to monitor a variety of brain damage index and brain tissue oxygen saturation (rSO 2 ), explore children PaO 2 and brain damage in an attempt to find the best during CPB PaO 2 level, aimed at reducing the damage to the nervous system in cardiac surgery to improve surgical results and improving the quality of life of children. Methods from August 2010 to January 2011 period in the Guangdong Provincial People's Hospital, younger than 3 years of age, pulse oximetry (SpO 2 ) lt; 85%, combined with the history, clinical manifestations and the Guangdong Provincial People's Hospital Heart B-or cardiac CT results, diagnosed with cyanotic CHD and corrective surgery in infants. In the prior informed consent of their legal guardians, all patients were randomly divided into three computer programs based on a prospective study groups: control group 1 (G1 group, n = 15), in full control during CPB PaO 2 at 80 ~ 120mmHg; control group 2 (G2 group, n = 15), in full control during CPB PaO 2 at 120 ~ 200mmHg; non-control group (G3 group, n = 15), in full control during CPB PaO 2 gt; 200mmHg. During CPB surgery, the application of continuous blood gas monitor for PaO 2 for continuous monitoring of oxygen through the air mixer adjustment of inspired oxygen (FiO 2 ) to control the PaO 2 . Before CPB, respectively, as well as immediately after the end of 3hr, 5hr, 24hr other five time points (T1 ~ T5) Determination of brain tissue oxygen saturation (rSO 2 ), and the radial artery catheter Blood samples were drawn at the tube, serum was separated, placed -80 ℃ low temperature refrigerator, followed by hand uniform testing S100β protein (S100β), neuron-specific enolase (NSE), adrenomedullin (ADM), superoxide dismutase (SOD), malondialdehyde (MDA) serum levels. Results A total of 45 cases and completed finally included in this study, including 32 males and 13 females; aged 1 month to 3 years, an average of 9.97 ± 8.24 months, of which 1 to 6 months in 15 patients, 6 months to 1 year of age, 25 cases, 1 to 3 years in 5 cases; weight 3.2 ~ 14.2 Kg, an average of 7.79 ± 2.53kg, where <5kg in 9 patients, 5 ~ 10kg 31 cases,> 10kg in 5 cases. According to the computer program randomly divided into three groups, three groups of children's age, weight and preoperative SpO 2 similar, except for CPB to maintain different levels of PaO 2 Outer other surgical exactly the same conditions. S100β: before the start of CPB, three observation group S100β protein serum levels are basically the same, but were significantly increased after CPB, including the G3 group (PaO 2 gt; 200mmHg) at time point T2 (CPB end) the most obvious, of up to 699 ± 139 pg / ml, significantly higher than the G1 group (PaO 2 80 ~ 120mmHg) and G2 group (PaO 2 120 ~ 200mmHg) in children, S100β levels and PaO 2 showed a significant positive correlation (r = 0.526, p = 0.008); After CPB, as time goes on, G3 group of children S100β protein serum levels declined steadily to 24hr time (T5 time point) is close to the preoperative level, while G1 group of children still see a slight increase, G2 group of children remained at a relatively stable level. NSE: before the start of CPB, three observation group NSE serum levels are basically the same; during CPB G1 in the group of children tended to increase, but no significant difference in the post-CPB 3hr and 5hr (T3, T4 time points) continues to rise, there is a significant difference; G2 group of children that have been in the process of CPB significantly increased after CPB 3hr and 5hr visible further increased to 24hr time (T5 point in time) with the G1 group of children is similar to a downward trend; G3 group of children were seen throughout the CPB significantly increased after CPB remained at a high level, no clear downward trend. At each time point, three observation groups were not significantly different. ADM: In the same study group at different time points, as well as the same time point between different observation groups were not significantly different. SOD: In the same study group at different time points, as well as the same time point between different observation groups were not significantly different. MDA: before the start of CPB, three observation group MDA serum levels similar to, but just at the end of CPB (T2 time point), were seen significantly increased after the end of CPB within 24hr, G1 group of children remained relatively high, G3 group of children with a gradual downward trend, while the G2 group of children is gradually reduced to the preoperative level. At each time point, three observation groups were not significantly different. rSO 2 : before the start of CPB, three observation group rSO 2 are similar, but just at the end of CPB (T2 time point), G3 group of children rSO 2 falling instead of rising, when in 3hr after CPB (T3 time point) before they see increased significantly, followed at a relatively stable level; G2 group of children was increased after the start of CPB and T3 time point at a stable level; while children in the G1 group after beginning CPB showed a slowly rising process. In addition to the time point T2 G3 group rSO 2 G2 group was significantly lower than the above, I between the two groups showed no significant difference. Conclusion cyanotic CHD patients during CPB perfusion hyperoxia can cause S100β protein, NSE, MDA serum levels increased, rSO 2 decreased, suggesting PaO 2 is too high may cause brain increased tissue damage, and the degree of injury and tissue perfusion PaO 2 were positively correlated. Intraoperative brain damage in children with CHD occurs mainly during CPB, suggesting that brain injury time in the therapeutic window after the end of CPB in its early. After the end of CPB, still pay attention to controlling PaO 2 , in order to prevent the recurrence of tissue damage.