The Research Of Monitoring Central Venous Oxygen Saturation In Infants With Congenital Heart Disease Postoperative

As for children with congenital heart disease (CHD), the custodial care in the cardiac surgical intensive care unit (Cardiac care unit CCU) after operation is very important for their survival, especially when they are accompanied by complex anatomic structure, pulmonary infection or severe hypertension pulmonary. An earlier discovery and proper treatment are keys to the care and treatment in the entire care period in CCU. Blood gas analysis, a commonly used test facility in CCU, is used to timely detect the change of biochemical indicator of blood gas for children in CCU. Among these blood gas analyses, blood oxygen saturation is usually detected to reflect the supply and demand of oxygen in children with congenital heart disease, which in turn to reflect the general condition of cardiac function and tissue instillation, and finally to provide reliable basis on which the timely diagnosis and treatment are based. There are studies showing that mixed venous oxygen saturation SCVO2surpasses arterial oxygen saturation SpO2in detective effectiveness, as the former can provide an earlier indication for the changes in illness, thus offers an earlier evidence of oxygen supply and demand in children with congenital heart disease. However, studies on the value of venous oxygen saturation monitoring in children with congenital heart disease are not abundant, with less studies on children with critical congenital heart disease, so it is difficult to acquire the mixed venous oxygen saturation. Studies have proved that mixed venous oxygen saturation SCVO2and central venous oxygen saturation SCVO2are strongly correlated, so we use central venous blood instead.Objective1. To explore the change pattern of central venous oxygen saturation SCVO2in children with congenital heart disease in CCU after operation, so as to provide earlier basis for prognosis and interference in CCU.2. To study the indicative role that different central venous oxygen saturation SCVO2play in the entire care period in CCU.Methods145cases involved in CHD surgery in Henan Diagnosis&Treatment Center of Congenital Heart Disease, the Third Affiliated Hospital of Zhengzhou University from March2011to April2011were collected, among which88cases were males and67females, whose ages at surgery range from4days to1year (7.13±2.76)M]; with body weight between2.3kg to13.5kg,[(4.45±3.30) kg]. Central venous blood and peripheral arterial blood were collected when the patients returned to the intensive care unit for Oh,0.5h,1h,4h,8h,12h,24h, and48h respectively. The gas analysis results of SpO2and SCVO2were then recorded.1:The patients were divided into severe congenital heart disease group and common heart disease group according to their anatomic structure, whether accompanied by pneumonia or pulmonary hypertension or not. Meanwhile, the patients were also grouped into arterial blood group and venous blood group in terms of the source of blood gas. By referring to the venous oxygen saturation on average in the first48hours, SCVO2≤45%is divided into low SCVO2group, SCVO2>65%is divided into the high SCVO2groups while45%<SCVO2≤65%is divided into the moderate SVO2group, with marked statistically (P <0.05) as the test standard. Rusults1. The tendency of SpO2in all children changes over time, but with no significant fluctuations; SCVO2declines gradually until4hours later when it comes to a normal level, but it changes little24hours later.2. The variation of SpO2and SCVO2in the common congenital heart disease follows the same tendency as all the patients do. SpO2do better than SCVO2do in indicating the changes of illness, which in turn show their cardiac function and tissue instillation in a more clearly way. From all the above, we can draw a conclusion that central venous blood plays is not very meaningful for the common congenital heart disease group.2:SCVO2changes earlier than SpO2in the severe congenital heart disease group, so the former can perform better in indicating patients’ cardiac function and tissue instillation than the latter do. That is to say, SCVO2is valuable to the severe congenital heart disease group. SCVO2infant crisis restructuring changes earlier than the SpO2.4h-8h will be a "relative" plateau, to prove SCVO2compared with SpO2response of children with cardiac function and tissue perfusion and therefore in danger, the reorganization of congenital heart disease in central venous oxygen has obvious implications3. The difference between the SCVO2in the common congenital heart disease and that in the severe congenital heart disease is statistically significant (p=0.030) With a better turnover among patients in the common group in death rate (p=0.028) and complications (p=0.01).4. The death rate p=0.034and complications p=0.018among high SCVO2group, low SCVO2group and moderate SCVO2group differ from each other greatly. Conclusions1. As for CHD postoperative care and treatment, SCVO2and SpO2in common congenital heart disease group cannot prognosticate the illness obviously, whil SVO2changes at an earlier stage than SpO2do in the severe congenital heart disease group, which plays an important role in scheduling an earlier intervention for the illness.2. A higher venous oxygen saturation implies a better prognosis, while a long-lasting low level after the operation for48hours indicates a poor prognosis.