Study On The Application Of Local Renal Regional Oxygenation Saturation Monitoring In Cardiopulmonary Bypass Infant Heart Operation

Background:Cardiopulmonary bypass?CPB?technology provides important assistance for the correction of congenital heart disease in infants.However,due to the redistribution of blood,the disappearance of physiological pulsatile blood flow,the release of inflammatory mediators and other factors affecting the perfusion of important tissues and organs in the whole body,it is easy to cause the perfusion disorder of important organs such as kidney.In the early stage,there is no non-invasive real-time monitoring tool for renal perfusion,and the monitoring of renal function changes is relatively lagging.Renal injury during cardiopulmonary bypass is usually only found when organ dysfunction occurs after surgery.The study shows that the incidence of acute renal injury?AKI?after CPB is as high as 11%?55%,and the mortality is as high as 20%?60%.NIRS is a non-invasive technique,which can continuously measure oxygen and deoxyhemoglobin in a regional tissue,and obtain regional oxygen saturation?r SO₂?,which is an important index reflecting the oxygen supply and demand of tissues and organs.In the clinical research of newborn and infant abroad,NIRS has been used as a reference index of tissue perfusion,and has been established as an important monitoring tool for hemodynamic management of critically ill children.However,there are few reports about the application of renal oxygen saturation?Rr SO₂?in infant heart surgery at home and abroad.Objective:By observing the changes of Rr SO₂ in the perioperative period of infant cardiac surgery,the significance of the application of Rr SO₂ in the perioperative period of cardiovascular surgery in such children was discussed,so as to provide some references for the protection of viscera.Method:From April 2019 to January 2020,53 children with ASD or VSD repaired by CPB in children's heart center of Henan people's Hospital were selected.After anesthesia,the position of the right kidney was determined by ultrasonic machine?Vivid E95;GE?,and the corresponding projection of the body surface was found out.After alcohol disinfection and degreasing,the S1 probe of NIRS monitor was fixed at the body surface location of the right kidney?T10-L2?.The transcutaneous renal oxygen saturation?Rr SO₂?was monitored,the initial baseline of Rr SO₂was recorded,and the data of Rr SO₂ during the operation were recorded continuously.After anesthesia induction?T₀?,immediately after cardiopulmonary bypass?T₁?,5minutes after aortic occlusion?T₂?,5 minutes after hypothermia?T₃?,5 minutes after aortic opening?T₄?,and 5 minutes after shutdown?T₅?,the changes of Rr SO₂,MAP and nasopharynx temperature were recorded.The general data of the patients were recorded,including age,weight,gender,preoperative EF value,preoperative hemoglobin,preoperative creatinine value,CPB time,aortic occlusion time,operation time,ventilator use time,ICU stay time and hospitalization time.The serum creatinine was measured in the peripheral venous blood before operation and the first morning after operation,and the renal function was evaluated according to AKI standard established by KDIGO:?1?the increase of Scr was?26.5?mmol/L in 48 hours;?2?the increase of Scr was more than 1.5 times of the basic value in 7 days;?3?the decrease of urine volume?<0.5ml/kg/h?and the duration was more than 6 hours.According to whether acute renal injury?AKI?occurred or not,the patients were divided into two group,A group?AKI group?and N group?no AKI group?.Result:1.In this study,53 children were included.15 children developed AKI,the incidence was 28.3%.There was no significant difference between the two groups at T₀?P>0.05?.The values of Rr SO₂in AKI group at T₁,T₂,T₃,T₄and T₅were significantly lower than those in the corresponding period without renal function damage?P<0.05?.There was no significant difference in MAP and nasopharyngeal temperature difference between the two groups?P>0.05?.In the AKI group,compared with T₀,the values of Rr SO₂were significantly lower at T₁,T₂,T₃ and T₄?P<0.05?,MAP and the temperature of nasopharynx was significantly lower at T₁,T₂,T₃and T₄?P<0.05?.The Rr SO₂ value of children without AKI decreased at T₁,and gradually increased at T₂,T₃,T₄ and T₅,with no statistically significant difference?P>0.05?.Compared with T₀,MAP decreased significantly?P<0.05?and nasopharynx temperature decreased significantly?P<0.05?at T₁,T_2,T₃ and T₄.2.The cardiopulmonary bypass time,aortic occlusion time,ventilator use time,ICU stay time and hospital stay time of children in AKI group were significantly higher than those in non AKI group?P<0.05?;there was no significant difference between the two groups in operation time?P>0.05?.3.Pearson correlation analysis showed that Rr SO₂was positively correlated with MAP?r=0.630,P=0.000?and negatively correlated with nasopharynx temperature?r=-0.494,P=0.000?.Conclusion:In infant heart operation,the continuous monitoring of Rr SO₂ can observe the renal tissue perfusion in real time and dynamically,provide basis for early prevention of renal ischemia during operation,reduce the incidence of perioperative acute renal injury,and improve the long-term prognosis of children.Renal NIRS can be used as a noninvasive renal function monitoring tool in infants undergoing cardiopulmonary bypass.