Is cerebral oxygen supply compromised in preterm infants undergoing surgical closure for patent ductus arteriosus?
Is cerebral oxygen supply compromised in preterm infants undergoing surgical closure for patent ductus arteriosus?
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DOI：
10.1136/adc.2009.180117
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发表时间：
2010-11-01
影响因子：
4.4
通讯作者：
van Bel, Frank
中科院分区：
文献类型：
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作者：
Lemmers, Petra M. A.;Molenschot, Mirella C.;van Bel, Frank
血流动力学上重要的动脉导管未闭（PDA）是早产儿脑损伤的危险因素。作者先前报道PDA婴儿的局部脑氧饱和度（rScO（2））较低，在给予吲哚美辛后恢复。目的探讨动脉导管未闭（PDA）手术闭合对近红外光谱法测定的rScO（2）和脑组织氧摄取分数（cFTOE）的影响，以及对振幅整合脑电图（aEEG）测定的脑活动的影响。（胎龄24.7 - 30.4周;结果术前rScO（2）中位数为53%（41-68%），术中rScO（2）中位数为53%（41-68%），但在导管夹闭前，为46%（31 - 89%）。11名婴儿在手术过程中血压下降，13名婴儿rScO（2）下降（范围2 - 21%），伴有aEEG振幅下降。12名婴儿在手术过程中rScO（2）值低于50%，5名低于40%。仅在术后24小时rScO（2）升高（61%（36 - 85%），p
Background A haemodynamically important patent ductus arteriosus (PDA) is a risk factor for brain damage in preterm infants. The authors previously reported lower regional cerebral oxygen saturation (rScO(2)) in infants with PDA, which recovered after administration of indomethacin. However, PDA ligation has been reported to pose an even higher risk of neurodevelopmental impairment.Objective To investigate the impact of surgical closure of PDA on rScO(2) and cerebral fractional tissue oxygen extraction (cFTOE), measured by near-infrared spectroscopy, and on amplitude-integrated electroencephalography (aEEG) measured brain activity.Design/methods In 20 preterm infants (gestational age 24.7-30.4 weeks; birth weight 630-1540 g), blood pressure, arterial saturation, rScO(2), cFTOE and aEEG were monitored before, during and up to 24 h after surgery.Results Before surgery, median (range) rScO(2) was 53% (41-68%), and during surgery, but before ductal clipping, it was 46% (31-89%). Eleven infants showed a drop in blood pressure and 13 infants a drop in rScO(2) during surgery (range 2-21%), accompanied by a decrease in aEEG amplitude. Twelve infants had rScO(2) values below 50% during surgery, with five being below 40%. Only at 24 h after surgery was rScO(2) higher (61% (36-85%), p