Changes in cerebral oxygen saturation during pediatric surgery in patients with cyanotic and non-cyanotic congenital heart defects

抄録

The clinical significance of cerebral oxygen saturation(rSO₂) measured by near-infrared spectroscopy during pediatric cardiac surgery has not been determined yet. We therefore evaluated the patterns of rSO₂ changes during pediatric cardiac surgery in patients with cyanotic and non-cyanotic heart defects and also evaluated the causes of changes from the physiological data.
One hundred eleven children under 6 years old who underwent cardiac surgery with cardio-pulmonary bypass(CPB) for congenital heart defects were divided into cyanotic and non-cyanotic groups. rSO₂ was measured every 5s throughout the surgery. The values were averaged before, during and after CPB. Intraoperative physiological data were collected at the start of surgery(T1), 5 min after the start of CPB(T2) and 10 min after the end of CPB(T3).
There were 58 patients in the non-cyanotic group and 53 patients in the cyanotic group. In the non-cyanotic group, the average rSO₂ during CPB was significantly lower than before and after CPB, and the mean arterial pressure and hemoglobin concentration were significantly lower at T2. In the cyanotic group, there were no significant differences of the average rSO₂ among the periods, although the physiological data, including the PaO₂ and hemoglobin levels, dramatically changed.
The patterns of rSO₂ changes during pediatric cardiac surgery with CPB were different between the cyanotic and non-cyanotic groups. Various changes of physiological data might affect the changes of rSO₂. The diversity of rSO₂ changes may be one of the causes of the non-establishment of rSO₂ monitoring in pediatric cardiac surgery.