An In Vivo Assessment of Regional Brain Temperature during Whole-Body Cooling for Neonatal Encephalopathy.
An In Vivo Assessment of Regional Brain Temperature during Whole-Body Cooling for Neonatal Encephalopathy.
复制标题
新生儿脑病全身冷却期间局部脑温度的体内评估。
DOI：
10.1016/j.jpeds.2020.01.019
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Blüml,Stefan
中科院分区：
文献类型：
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作者：
Wu,Tai-Wei;LWisnowski,Jessica;Geisler,RobertF;Reitman,Aaron;Ho,Eugenia;Tamrazi,Benita;Chapman,Rachel;Blüml,Stefan
目的评估全身低温期间局部脑温的差异，验证缺氧缺血性脑病患儿脑温分布不均匀的假说。研究设计：前瞻性研究。在低温治疗过程中，采集基底节、丘脑、皮质灰质和白质的磁共振波谱。在进行校准测量后，根据水信号和MR光谱中代谢物之间的化学位移差来计算局部脑组织温度。采用混合效应模型分析各区域温度的总体差异，并对不同类型的温度和MR图像上的损伤程度进行分析。结果共入选53例新生儿，其中女婴31例，平均胎龄38.6±10.2周；平均出生体重3243±0.613 ng。磁共振波谱测量的平均年龄为2.2±0.6天。分析中共包括201个磁共振波谱。丘脑是最深的结构(距颅面36.4±22.3℃)，温度最低(33.2±20.8℃，与基底节：33.5±20.9℃；灰质：33.6±100.7℃；白质：33.8±0.9℃，均P<；.001)。浅层灰质区和WM区的温度(深度分别为21.9℃±22.4 mm和21.5℃±22.2 mm)高于直肠温度(33.4℃±0.4℃，P<0.01)。温度与脑结构深度呈负相关(−=0.36，P&t；.001)。结论体腔低温对脑深层结构降温效果较好，而浅层结构温度较高，体温明显高于直肠温度。
ObjectiveTo assess differences in regional brain temperatures during whole-body hypothermia and test the hypothesis that brain temperature profile is nonhomogenous in infants with hypoxic–ischemic encephalopathy.Study designInfants with hypoxic–ischemic encephalopathy were enrolled prospectively in this observational study. Magnetic resonance (MR) spectra of basal ganglia, thalamus, cortical gray matter, and white matter (WM) were acquired during therapeutic hypothermia. Regional brain tissue temperatures were calculated from the chemical shift difference between water signal and metabolites in the MR spectra after performing calibration measurements. Overall difference in regional temperature was analyzed by mixed-effects model; temperature among different patterns and severity of injury on MR imaging also was analyzed. Correlation between temperature and depth of brain structure was analyzed using repeated-measures correlation.ResultsIn total, 53 infants were enrolled (31 girls, mean gestational age: 38.6 ± 2 weeks; mean birth weight: 3243 ± 613 g). MR spectroscopy was acquired at mean age of 2.2 ± 0.6 days. A total of 201 MR spectra were included in the analysis. The thalamus, the deepest structure (36.4 ± 2.3 mm from skull surface), was lowest in temperature (33.2 ± 0.8°C, compared with basal ganglia: 33.5 ± 0.9°C; gray matter: 33.6 ± 0.7°C; WM: 33.8 ± 0.9°C, allP< .001). Temperatures in more superficial gray matter and WM regions (depth: 21.9 ± 2.4 and 21.5 ± 2.2 mm) were greater than the rectal temperatures (33.4 ± 0.4°C,P< .03). There was a negative correlation between temperature and depth of brain structure (rrm= −0.36,P< .001).ConclusionsWhole-body hypothermia was effective in cooling deep brain structures, whereas superficial structures were warmer, with temperatures significantly greater than rectal temperatures.