Monitoring of Cerebrovascular Reactivity for Determination of Optimal Blood Pressure in Preterm Infants
Monitoring of Cerebrovascular Reactivity for Determination of Optimal Blood Pressure in Preterm Infants
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DOI：
10.1016/j.jpeds.2015.03.041
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发表时间：
2015-07-01
影响因子：
5.1
通讯作者：
Austin, Topun
中科院分区：
文献类型：
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作者：
da Costa, Cristine Sortica;Czosnyka, Marek;Austin, Topun
目的确定早产儿脑血管反应性最强的平均动脉血压（MABP）水平（即，最佳MABP，或MABP（OPT）），并将MABP（OPT）的偏离与死亡率和脑室内出血（IVH）相关。在中位年龄34小时（范围5-228）时研究了23 +/- 2至32 +/- 1例留置动脉导管的患者。估计脑血管反应性的组织氧合心率（HR）反应性指数计算为用近红外光谱法测量的组织氧合指数的慢波与HR之间的移动相关系数。MABP（OPT）通过将MABP划分为2 mm Hg箱并对这些箱内的组织氧合HR反应性指数求平均来定义。结果81%的患者有个体MABP（OPT）。与存活患者（平均2.1 mm Hg; 95% CI 1.64-2.56）相比，死亡患者（平均4.2 mm Hg; 95% CI 3.33-4.96）与MABP（OPT）的偏离测量值更大，P = 0.013。MABP低于MABP（OPT）4 mm Hg或以上的患者的死亡率（40%）高于MABP接近或高于MABPOPT的患者（13%），P = 0.049。MABP大于MABPOPT 4 mm Hg的患者IVH评分更高，P = 0.042。结论连续监测脑血管反应性可以确定早产儿的MABP（OPT）。在死亡婴儿中观察到低于MABP（OPT）的显着偏差。在IVH较严重的婴儿中观察到MABP高于最佳水平的偏差。
Objective To define levels of mean arterial blood pressure (MABP) where cerebrovascular reactivity is strongest in preterm infants (ie, optimal MABP, or MABP(OPT)) and correlate deviations from MABP(OPT) with mortality and intraventricular hemorrhage (IVH).Study design A total of 60 preterm infants born at median gestational age 26 +/- 2 weeks (23 +/- 2 to 32 +/- 1) with indwelling arterial catheter were studied at a median 34 hours (range 5-228) of age. Tissue oxygenation heart rate (HR) reactivity index, which estimates cerebrovascular reactivity, was calculated as the moving correlation coefficient between slow waves of tissue oxygenation index, measured with near-infrared spectroscopy, and HR. MABP(OPT) was defined by dividing MABP into 2-mm Hg bins and averaging the tissue oxygenation HR reactivity index within those bins. A measurement of divergence from MABP(OPT) was calculated as the absolute difference between mean MABP and mean MABP(OPT).Results Individual MABP(OPT) was defined in 81% of the patients. A measurement of divergence from MABP(OPT) was greater in those patients who died (mean 4.2 mm Hg; 95% CI 3.33-4.96) compared with those who survived (mean 2.1 mm Hg; 95% CI 1.64-2.56), P = .013. Patients who had MABP lower than MABP(OPT) by 4 mm Hg or more had a greater rate of mortality (40%) than those with MABP close to or above MABPOPT (13%), P = .049. Patients with MABP greater than MABPOPT by 4 mm Hg had greater IVH scores, P = .042.Conclusions Continuous monitoring of cerebrovascular reactivity allows the determination of MABP(OPT) in preterm neonates. Significant deviation below MABP(OPT) was observed in infants who died. Deviation of MABP above optimal level was observed in infants who developed more severe IVH.