End-Organ Saturation Differences in Early Neonatal Transition for Left-versus Right-Sided Congenital Heart Disease
End-Organ Saturation Differences in Early Neonatal Transition for Left-versus Right-Sided Congenital Heart Disease
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DOI：
10.1159/000487472
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发表时间：
2018-01-01
期刊：
影响因子：
2.5
通讯作者：
Chock, Valerie Y.
中科院分区：
文献类型：
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作者：
Altit, Gabriel;Bhombal, Shazia;Chock, Valerie Y.
背景：对于先天性心脏病(CHD)新生儿，左侧(LL)和右侧(RL)单心室生理学(LL，左心发育不良综合征；RL，三尖瓣闭锁或肺闭锁伴完整的室间隔)在出生后72 h内可能会显示出明显的组织饱和度变化。近红外光谱(NIRS)可以测量局部脑饱和度(Csat)和肾脏饱和度(Rsat)，以澄清LL和RL随时间的差异。目的：我们的主要目标是用近红外光谱测量患有LL和RL的CHD婴儿在生命的前72小时内的Csat和Rsat的变化。第二个目标是将NIRS值与超声心动图血流灌注标记物相关联。方法：对2013-2016年间收治的左心发育不良综合征、三尖瓣闭锁和室间隔完整的肺闭锁患儿进行常规近红外光谱监测。回顾分析出生后72h的CSAT、Rsat和全身血氧饱和度(SpO(2))，并测量降主动脉血流速度时间积分(VTI)。混合效应模型比较了LL和RL之间随时间的差异。结果：最终队列包括13例LL、12例RL和4例对照。与LL相比，RL的CSAT降低(p=0.005)，而两者的RSAT降低(p=0.008)。随着时间的推移，LL的Spo(2)增加，RL的Spo(2)减少(p=0.046)。与对照组相比，CHD患儿的Csat降低，Rsat降低，SpO2降低。降主动脉VTI与Rsat呈正相关(R2=0.24，P=0.02)。结论：与RL相比，L1的NIRS Csat测量保存得更好。随着时间推移，两组RSAT均呈下降趋势。降主动脉VTI和Rsat之间的相关性表明NIRS测量的肾饱和度和肾血流灌注之间存在关联。(C)2018年S.Karger AG，巴塞尔
Background: For neonates with congenital heart disease (CHD), left-sided (LL) and right-sided (RL) single ventricular physiologies (LL, hypoplastic left heart syndrome; RL, tricuspid atresia or pulmonary atresia with intact ventricular septum) may demonstrate distinct changes in tissue saturation in the first 72 h of life. Near-infrared spectroscopy (NIRS) can measure regional cerebral saturation (Csat) and renal saturation (Rsat) to clarify differences between LL and RL over time. Objectives: Our primary objective was to measure changes in Csat and Rsat in the first 72 h of life using NIRS between CHD infants with LL compared to RL. The secondary objective was to correlate NIRS values to an echocardiographic marker of perfusion. Method: Newborns with hypoplastic left heart syndrome, tricuspid atresia, and pulmonary atresia with intact ventricular septum from 2013 to 2016 underwent routine NIRS monitoring. Csat, Rsat, and systemic saturations (SpO(2)) in the first 72 h of life were retrospectively analyzed and the echocardiographic descending aorta velocity time integral (VTI) was measured. Mixed effects models compared differences over time between LL and RL. Results: The final cohort included 13 LL, 12 RL, and 4 controls. Csat decreased for RL compared to LL (p = 0.005), while Rsat decreased for both (p = 0.008). Over time, SpO(2) increased for LL but decreased for RL (p = 0.046). Compared to the controls, infants with CHD had lower Csat, lower Rsat, and lower SpO2. The descending aorta VTI was correlated with Rsat (R-2 = 0.24, p = 0.02). Conclusion: NIRS Csat measures were better preserved in LL compared to RL. Rsat decreased in both groups through time. The correlation between the descending aorta VTI and Rsat suggests an association between NIRS measures of renal saturation and renal perfusion. (c) 2018 S. Karger AG, Basel