Surfactant administration acutely affects cerebral and systemic hemodynamics and gas exchange in very-low-birth-weight infants
Surfactant administration acutely affects cerebral and systemic hemodynamics and gas exchange in very-low-birth-weight infants
复制标题
DOI：
10.1016/j.jpeds.2004.03.022
复制
发表时间：
2004-06-01
影响因子：
5.1
通讯作者：
Williams, DK
中科院分区：
文献类型：
--
作者：
Kaiser, JR;Gauss, CH;Williams, DK
目的探讨表面活性剂对极低出生体重儿脑及全身血流动力学及气体交换的影响，并探讨影响表面活性剂注入后平均脑血流速度（mCBFv）变化的主要因素。研究设计对14例极低出生体重呼吸窘迫综合征患儿在第二次给药前、给药期间和给药后连续监测mCBFv、PaCO2、平均动脉血压（MABP）和PaO2。计算了表面活性剂作用45 min后4个变量的峰值和相对变化。采用Logistic回归法确定表面活性剂处理后mCBFv变化的主要影响因素。结果出生体重832±162 g，胎龄25.7±1.5周。从出生到监测时间为6.9±1.0小时。平均CBFv增加75.7% +/- 51.6%，达到峰值14.4 +/- 5.9分钟。PacCO(2)与mCBFv高度相关（OR = 107.3, P < 0.0001）；随着PaCO2的升高，mCBFv升高。相比之下，MABP （OR = 6.7, P = 0.047）对mCBFv的影响较小。PaO2与mCBFv无相关性。结论给药后mCBFv的升高主要是由于PaCO2的升高，而不是由于MABP的改变。
Objectives To determine whether surfactant administration affects cerebral and systemic hemodynamics and gas exchange in very low birth weight infants and to determine the predominant factor influencing changes in mean cerebral blood flow velocity (mCBFv) after surfactant instillation.Study design Fourteen very low birth weight infants with respiratory distress syndrome had continuous monitoring of mCBFv PaCO2, mean arterial blood pressure (MABP), and PaO2 before, during, and after the second dose of surfactant. Peak values and relative changes of the 4 variables for 45 minutes after surfactant were calculated. Logistic regression was used to determine the predominant factor influencing changes in mCBFv after surfactant.Results Birth weight was 832 +/- 162 grams and gestational age was 25.7 +/- 1.5 weeks. The time from birth to monitoring was 6.9 +/- 1.0 hours. Mean CBFv increased 75.7% +/- 51.6% after surfactant and peaked at 14.4 +/- 5.9 minutes. PacCO(2) was highly associated (OR = 107.3, P < .0001) with mCBFv; as PaCO2 increased, mCBFv increased. In contrast, MABP (OR = 6.7, P = .047) had less impact on mCBFv. PaO2 was not associated with mCBFv.Conclusions The increases in mCBFv after surfactant administration were predominantly due to increases in PaCO2 and not changes in MABP.