Effect Of Hemodynamic With R Sc O₂and Pcv-aCO₂ As The Main Goal On Short Term The Prognosis Of Children With Cyanotic Congenital Heart Disease

Objective:To investigate the effect of hemodynamic of r Sc O₂and Pcv-a CO₂as the main goal on the short term prognosis of cyanotic congenital heart disease of psychiatrics.Methods:72 cases of 0～1 year old with cyanotic congenital heart disease（CCHD）born from October 2020 to June 2021 in the Seventh Medical Center of PLA General Hospital who underwent cardiac surgery under cardiopulmonary bypass（CPB）were selected as the research objects.They were randomly divided into a control group and an intervention group,with 36 cases in each group.The control group was implemented the traditional cyclic management strategy,by adjusting the blood flow and vasoactive drugs,the mean arterial pressure（MAP）was maintained within±20%,and the lactate（Lac）,central venous oxygen saturation（Scv O₂）,hemoglobin（Hb）and arterial partial pressure of carbon dioxide（Pa CO₂）were adjusted by regulating the blood flow and temperature.The intervention group implemented a perioperative individualized circulatory management strategy with r Sc O₂and Pcv-a CO₂as the main targets.When the local cerebral oxygen saturation（r Sc O₂）is lower than 20%of the basic value or the absolute value is lower than 50,the individualized circulatory management strategy is activated.By adjusting MAP,Hb,arterial oxygen saturation（Sa O₂）,Pa CO₂,central venous-arterial partial pressure of carbon dioxide（Pcv-a CO₂）levels until the child’s r Sc O₂returns to the normal range.The MAP of endotracheal intubation opening the arteries and veins（T₁）,5 minutes after ascending aorta clipping（T₂）,5 minutes after ascending aorta opening（T₃）,end of ultrafiltration（T₄）,3 hours after end of CPB（T₅）,8 hours after end of CPB（T₆）and 24hours after end of CPB（T₇）of the two groups of children were recorded,respectively,as well as the pharyngeal temperature（T）,Hb,Sa O₂,Pa CO2,r Sc O₂,Pcv-a CO₂,Lac and Scv O₂,CPB time,operation time,extubation time,ICU stay,discharge time,and acute kidney injury（AKI）,lung infection,and respiratory failure.Results:There was no significant difference in MAP,T,Hb and Sa O₂between the twogroups at T₁～T₇（P>0.05）.Compared with the control group,Pa CO₂in the intervention group was significantly increased at T₂,T₃,T₆and T₇,r Sc O₂was significantly increased at T₃～T₆（P<0.05）,and Pcv-a CO₂was significantly decreased at T₁～T₇（P<0.05）.Lac levels were significantly decreased at T₃and T₅（P<0.05）,and Scv O₂levels were significantly decreased at T₂and T₃（P<0.05）.There was no significant difference in CPB time,operation time,extubation time,postoperative pulmonary infection and respiratory failure rate between the two groups（P>0.05）.The ICU stay time and hospital stay in the intervention group were significantly shorter than those in the control group[ICU stay time:（5.67±1.50）d vs.（7.28±2.11）d,P<0.05);hospital stay:（14.67±3.41）d vs.（19.00±2.63）d,P<0.05],the incidence of postoperative AKI was significantly lower than the control group[25.0%（9/36）vs.50.0%（18/36）,P<0.05].Conclusion:In the perioperative period,the individualized circulation management strategy with r Sc O₂and Pcv-a CO₂has a significant effect on the short term prognosis of children with CCHD.