Cerebral oxygenation and cerebral oxygen extraction in the preterm infant: the impact of respiratory distress syndrome
Cerebral oxygenation and cerebral oxygen extraction in the preterm infant: the impact of respiratory distress syndrome
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DOI：
10.1007/s00221-006-0388-8
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发表时间：
2006-08-01
影响因子：
2
通讯作者：
van Bel, Frank
中科院分区：
文献类型：
--
作者：
Lemmers, Petra M. A.;Toet, Mona;van Bel, Frank
血流动力学因素在早产儿脑损伤的病因学中起着重要作用。呼吸窘迫综合征（RDS）是早产儿的常见问题，与低且波动的动脉血压密切相关。本研究调查了生命最初 72 小时内平均动脉压 (MABP)、脑氧饱和度分数 (ScO2) 和（大脑）组织氧提取分数 (FTOE) 之间的关系，FTOE 是大脑氧利用率的衡量标准。纳入 38 名婴儿（胎龄 < 32 周），其中 18 名患有 RDS，20 名没有 RDS。连续测量动脉血氧饱和度（SaO(2)）、MABP 和近红外光谱测定的 ScO2。 FTOE 计算为比率：(SaO(2)-ScO2)/SaO(2)。各组之间的胎龄和出生体重没有差异，但辅助通气和正性肌力药物的使用在 RDS 婴儿中更为常见（P < 0.01）。 RDS 患者的 MABP 较低（出生后 12 至 36 小时，P < 0.05），但随着时间的推移，两组均有所增加。随着时间的推移，各组之间的 ScO2 和 FTOE 没有差异，但在 RDS 婴儿中，ScO2 和 FTOE 具有显着较大的方差（除 36-48 小时 ScO2 外，所有时间点 P < 0.05，FTOE 在 12-18、18-24、36-48 和 48-60 小时 P < 0.05）。在生命的前72小时内，RDS婴儿表现出更多的MABP和ScO2之间的正相关（P < 0.05，18-24、24-36、36-48、48-60 h）和MABP与FTOE之间的负相关（P < 0.05，18-24、36-48 h）。虽然我们发现 RDS 婴儿的脑氧合和提取模式与没有 RDS 的婴儿没有不同，但我们认为 RDS 婴儿可能缺乏脑自动调节的频繁周期可能使这些婴儿更容易受到脑损伤。
Haemodynamic factors play an important role in the etiology of cerebral lesions in preterm infants. Respiratory distress syndrome (RDS), a common problem in preterms, is strongly related with low and fluctuating arterial blood pressure. This study investigated the relation between mean arterial blood pressure (MABP), fractional cerebral oxygen saturation (ScO2) and fractional (cerebral) tissue oxygen extraction (FTOE), a measure of oxygen utilisation of the brain, during the first 72 h of life. Thirty-eight infants (gestational age < 32 week) were included, 18 with and 20 without RDS. Arterial oxygen saturation (SaO(2)), MABP and near infrared spectroscopy-determined ScO2 were continuously measured. FTOE was calculated as a ratio: (SaO(2)-ScO2)/SaO(2). Gestational age and birth weight did not differ between groups, but assisted ventilation and use of inotropic drugs were more common in RDS infants (P < 0.01). MABP was lower in RDS patients (P < 0.05 from 12 up to 36 h after birth), but increased in both groups over time. ScO2 and FTOE were not different between groups over time, but in RDS infants ScO2 and FTOE had substantial larger variance (P < 0.05 at all time points except at 36-48 h for ScO2 and P < 0.05 at 12-18, 18-24, 36-48 and 48-60 h for FTOE). During the first 72 h of life, RDS infants showed more periods of positive correlation between MABP and ScO2 (P < 0.05 at 18-24, 24-36 36-48 48-60 h) and negative correlation between MABP and FTOE (P < 0.05 at 18-24, 36-48 h). Although we found that the patterns of cerebral oxygenation and extraction in RDS infants were not different as compared to infants without RDS, we suggest that the frequent periods with possible lack of cerebral autoregulation in RDS infants may make these infants more vulnerable to cerebral damage.