Cerebral oxygen metabolism in neonatal hypoxic ischemic encephalopathy during and after therapeutic hypothermia
Cerebral oxygen metabolism in neonatal hypoxic ischemic encephalopathy during and after therapeutic hypothermia
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DOI：
10.1038/jcbfm.2013.165
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发表时间：
2014-01-01
影响因子：
6.3
通讯作者：
Grant, P. Ellen
中科院分区：
文献类型：
--
作者：
Dehaes, Mathieu;Aggarwal, Alpna;Grant, P. Ellen
新生儿缺氧缺血性脑病（HIE）的病理生理机制涉及复杂的血流和代谢变化。治疗性低温（TH）可有效减轻脑损伤的程度，但TH对脑血流量（CBF）和代谢的影响尚不清楚。10名新生儿接受TH治疗HIE和17名健康对照分别从NICU和婴儿保育室招募。频域近红外光谱（FDNIRS）和扩散相关光谱（DCS）系统的组合被用来在床边非侵入性地测量脑血流动力学和代谢变量。结果表明，新生儿缺氧缺血性脑病（HIE）TH时脑氧代谢（CMRO 2 i）和脑血流量（CBFi）明显低于TH后及同龄对照组。此外，脑血容量（CBV）和血红蛋白氧饱和度（SO2）在TH期间与年龄匹配的对照新生儿相比，HIE的新生儿显着较高。TH后的CBV显着降低，而SO2治疗后保持不变。因此，FDNIRS-DCS可以提供与SO2互补的信息，并可以评估个体对TH的脑代谢反应。组合FDNIRS-DCS参数提高了对潜在生理学的理解，并有可能作为治疗反应和优化的床旁生物标志物。
Pathophysiologic mechanisms involved in neonatal hypoxic ischemic encephalopathy (HIE) are associated with complex changes of blood flow and metabolism. Therapeutic hypothermia (TH) is effective in reducing the extent of brain injury, but it remains uncertain how TH affects cerebral blood flow (CBF) and metabolism. Ten neonates undergoing TH for HIE and seventeen healthy controls were recruited from the NICU and the well baby nursery, respectively. A combination of frequency domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) systems was used to non-invasively measure cerebral hemodynamic and metabolic variables at the bedside. Results showed that cerebral oxygen metabolism (CMRO2i) and CBF indices (CBFi) in neonates with HIE during TH were significantly lower than post-TH and age-matched control values. Also, cerebral blood volume (CBV) and hemoglobin oxygen saturation (SO2) were significantly higher in neonates with HIE during TH compared with age-matched control neonates. Post-TH CBV was significantly decreased compared with values during TH whereas SO2 remained unchanged after the therapy. Thus, FDNIRS-DCS can provide information complimentary to SO2 and can assess individual cerebral metabolic responses to TH. Combined FDNIRS-DCS parameters improve the understanding of the underlying physiology and have the potential to serve as bedside biomarkers of treatment response and optimization.