近红外光谱对早产儿脑组织氧饱和度监测的临床应用

与经皮血氧饱和度(percutaneous oxygen saturation,SpO 2)相比,脑组织氧饱和度(cerebral regional tissue oxygen saturation,CrSO 2)反映的是脑组织的混合氧饱和度,其变化与新生儿生后脑组织的新陈代谢密切相关。近红外光谱技...     

不同疾病状态下新生儿脑组织氧合变化的对照研究

目的采用近红外光谱测定技术(NIRS)检测新生儿脑组织氧饱和度（rSO2）,探讨不同疾病状态下新生儿脑rSO2的变化规律,为临床应用提供依据。方法2007年4月至2008年10月以无特殊疾病的223名足月儿作为正常组足月儿亚组,于生后3 d内测定脑rSO2;以196例患有可能影响脑氧合疾病的新生儿作为疾病组,在疾病急性期测定脑rSO2。疾病组分为呼吸系统疾病亚组（97例）,分析脑rSO2与PaO2 的关系;循环系统疾病亚组（44例）,分析脑rSO2与心率的关系;脑损伤亚组（55例）,分析脑rSO2与脑血流的关系。结果①疾病组脑rSO2为（56±6）％,显著低于正常组足月儿亚组(P<0.05)。②轻度与重度呼吸系统疾病亚组脑rSO2分别为（60±3）％和（54±6）％,轻度和重度循环系统疾病亚组脑rSO2分别为（59±3）％和（53±6）％,轻度和重度脑损伤亚组脑rSO2分别为（59±3）％和（54±4）％。3个疾病亚组中轻度与重度间脑rSO2差异均有统计学意义(P<0.01)。③呼吸系统疾病亚组脑rSO2与PaO2呈三次方程曲线(y=-62.93+4.75x-0.059x2+0.00024x3)。PaO2≥60 mmHg时,脑rSO2约为62%,脑氧合正常;PaO2<50 mmHg时,脑rSO2<57%,脑组织缺氧。循环系统疾病亚组脑rSO2与心率呈二次方程曲线（y=1.11+0.8241x-0.0027x2）。心率在105~200·min-1时,脑rSO2>58%,脑氧合正常;心率低于105·min-1或高于200·min-1时,脑rSO2<58%,脑组织缺氧。脑损伤亚组脑rSO2<58%时,大脑前动脉血流平均速度代偿性增高,阻力指数偏低,脑损伤较重。结论严重疾病状态下可同时伴有脑组织缺氧。脑rSO2的变化与PaO2、心率及脑血流的变化密切相关。NIRS技术为临床提供了一种可靠的、有价值的脑氧合检测方法,有助于临床直观量化地发现脑组织的缺氧。     

疾病状态下新生儿脑组织氧饱和度的测定

目的测定有围产期脑损伤的足月新生儿、不同胎龄早产儿的脑组织氧饱和度。方法应用TSNIR蛳3无创组织氧监测仪,测定44例围产期脑损伤的足月新生儿、198例不同胎龄早产儿的脑组织氧饱和度,并与90例对照组进行比较。结果脑损伤的足月新生儿脑组织氧饱和度为(54.9±5.2)%,对照组为(61.3±3.9)%,两者相比差异有统计学意义。不同胎龄早产儿脑组织氧饱和度不同,随着胎龄的增长,脑组织氧饱和度呈上升趋势,32周以上的早产儿脑组织氧饱和度接近足月儿。结论脑损伤患儿的脑组织氧饱和度低于对照组;早产儿随着脑血管发育的不断成熟,32周以上的早产儿脑组织氧饱和度已接近足月儿的水平。     

红细胞持续输注3小时和4小时改善贫血早产儿脑组织氧合的非随机对照试验

目的：探讨红细胞持续输注（本文简称输血）3 h和4 h对贫血早产儿脑、肠、肾组织氧合的影响。 方法：以在复旦大学附属儿科医院（我院）新生儿科住院、胎龄<37周、符合早产儿输血指征的早产儿为研究对象,以我院新生儿科二和三病区分别为输血3 h和4 h组,设定输血3 h和4 h后可接受的CrSO2变化差值为4%;主要结局指标：输血后12~24 h时间段的脑组织氧饱和度（CrSO2 );次要结局指标：输血前2 h、输血过程中和之后2、~4、~6、~12 h时间段的脑组织氧饱和度（CrSO2 ),输血前2 h、输血过程中和之后2、~4、~6、~12和~24 h时间段肠组织氧饱和度（SrSO2）和肾组织氧饱和度（RrSO2）,输血前2 h、输血过程中和之后2 h每搏输出量（SV）、心输出量（CO）、心率（HR）、经皮动脉氧饱和度（TcSaO2）和平均动脉血压（MABP）。采用非劣效检验分析两组患儿组织氧饱和度、心功能指标和基本生命体征参数输血前后差值的差异性。 结果：①符合本文纳入、排除和剔除标准的患儿共52例。输血3 h和4 h组分别为21和31例,输血时矫正胎龄分别为（38.6±4.3）和（36.4±3.1）周（P=0.033）。②输血3 h组输血前后CrSO2、SrSO2和RrSO2分别为（0.573±0.025） vs （0.600±0.017）、（0.530±0.038） vs （0.561±0.032）、（0.564±0.035） vs （0.595±0.037）,输血4 h组输血前后CrSO2、SrSO2和RrSO2分别为（0.573±0.045） vs （0.596±0.033）、（0.543±0.052） vs （0.552±0.052）、（0.533±0.063） vs （0.576±0.050）;两组患儿组内比较,输血前后CrSO2、SrSO2和RrSO2差异均有统计学意义（P均<0.05）;组间比较,CrSO2、SrSO2和RrSO2输血前后差值差异均无统计学意义,非劣效检验成立。③两组患儿组内比较,输血前后HR和MABP差异均有统计学意义（P均<0.05）。 结论对于输血时矫正胎龄大于38周的早产儿组织氧合影响输血3 h不劣于常规的输血4 h。     

早产儿视网膜病变病因学研究进展

早产儿视网膜病变（ROP）的病因尚未完全清楚。目前公认早产儿、低出生体质量儿、吸氧为本病的主要高危因素，国内外众多关于ROP发病因素的报道已证实，早产儿诸多发育的缺陷是导致ROP的基础的结论是没有争议的，其中吸氧与ROP的关系仍是临床上争论的焦点问题，本文结合国内外最新科研成果，对吸氧与ROP的关系等问题进行综述，以寻求解决方案。     

早产儿脑血流自主调节功能的研究

通过对早产儿脑血流及平均动脉压变化水平进行监测,了解早产儿的脑血流自主调节功能,探讨受损的脑血流自主调节与脑损伤的关系,对55例早产儿按胎龄分为早产Ⅰ组20例(胎龄＜32周)和早产Ⅱ组35例(胎龄＞32周).所有病例均在生后72小时内开始床旁近红外光谱仪(Near-Infrared Spectroscopy,NIRS)及平均动脉压(mean arterial blood pressure,MABP)的监测来判断脑血流自主调节功能;并对所有病例进行头颅B超,随访以判定脑损伤.结果胎龄＜32周20例早产儿中有9例自主调节功能受损(9/20,45%),胎龄≥32周35例早产儿中仅3例自主调节功能受损(3/35,8.6%);有自主调节功能受损者33.3%随后发生严重脑损伤,明显高于自主调节功能良好者,P＜0.01.结论胎龄＜32周早产儿易出现脑血流自主调节功能受损,受损的脑血流自主调节与随后严重脑损伤的发生关系密切.     

新生儿脑氧合及脑功能监测的意义

围生期新生儿易发生各种类型的缺氧，导致脑损伤，严重者遗留神经系统后遗症。早期客观评价新生儿脑氧合、血流动力学、脑反应的改变，及时发现并治疗脑组织缺氧，已成为临床迫切需要解决的问题。近红外光谱技术（Near Infrared Spectroscopy，NIRS）可直接反映组织中氧与血红蛋白的氧合与解离情况，表明组织中的血氧合状态，是脑组织氧合、血流及灌注客观评价的手段，     

局部脑组织氧饱和度监测在新生儿生后早期的应用价值

局部脑组织氧饱和度(regional cerebral oxygenation,rSO2)监测的应用范围很广,不受温度和搏动血流影响,是一种监测脑组织氧合状态的新方式,但目前在新生儿方面的研究较少.本文针对不同病理状况对新生儿生后早期rSO2的影响进行综述,阐明新生儿rSO2监测的重要临床意义并对其未来应用范围进行展望.     

近红外光谱技术对新生儿脑组织氧检测的应用与展望

氧是维持人体组织细胞正常功能和生命活动的基础。一旦缺氧,可威胁到全身各系统的代谢与功能,尤其对中枢神经系统的危害更引人关注,因为在缺氧时脑细胞的生物氧化过程可发生障碍,可导致神经元急性坏死和凋亡,使小儿留下终生残疾。多年来,在临床工作中,机体的氧合状况始终是倍受关注的生命监测指标之一,但目前广泛应用的血气分析和经皮氧饱和度监测所得到的结果仅是血液中的氧分压和肢端搏动的小动脉血氧饱和度,而不是脑组     

早产儿胃肠功能障碍的临床研究

目的 探讨早产儿胃肠功能障碍的发生率、发病因素及预后.方法 分析206例早产儿不同出生体质量及胎龄与胃肠功能障碍发生率的关系.比较早产儿在合并窒息、感染情况下胃肠功能障碍的发生率.检测早产儿胃肠功能障碍组及非胃肠功能障碍组乳酸(LAC)水平,计算2组病死率.结果 206例早产儿胃肠功能障碍的发生率为21.36%(44/206例).低出生体质量儿与极低出生体质量儿胃肠功能障碍的发生率比较差异有统计学意义(χ2=13.598,P=0.000 2);胎龄≤32周的早产儿与胎龄>32周的早产儿胃肠功能障碍的发生率比较差异有统计学意义(χ2=6.904,P=0.009 0);出生后有窒息史及合并感染的早产儿胃肠功能障碍的发生率均明显升高(Pa<0.01).胃肠功能障碍组早产儿LAC水平明显高于非胃肠功能障碍组(t=32.849,P<0.001),且2组病死率比较差异有统计学意义(χ2=6.032,P=0.014 0).结论 早产儿胃肠功能障碍的发生率较高,尤其是极低出生体质量及胎龄≤32周的早产儿,且与窒息、感染等因素有关.血LAC参数的变化可作为早产儿发生胃肠功能障碍的警示参数及诊断参考指标.早产儿出现胃肠功能障碍病死率明显增加,应重视对其早期干预.     

Target Oxygen Saturation Among Preterm Neonates on Supplemental Oxygen Therapy: A Quality Improvement Study

Objective

To avoid excessive oxygen exposure and achieve target oxygen saturation (SpO₂) within intended range of 88%–95% among preterm neonates on oxygen therapy.

Methods

20 preterm neonates receiving supplemental oxygen in the first week of life were enrolled. The percentage of time per epoch (a consecutive time interval of 10 hours/day) spent by them within the target SpO₂ range was measured in phase 1 followed by implementation of a unit policy on oxygen administration and targeting in phase 2. In phase 3, oxygen saturation histograms constructed from pulse-oximeter data were used as daily feedback to nurses and compliance with oxygen-targeting was measured again.

Results

48 epochs in phase 1 and 69 in phase 3 were analyzed. The mean (SD) percent time spent within target SpO₂ range increased from 65.9% (21.4) to 76.5% (12.6) (P=0.001).

Conclusion

Effective implementation of oxygen targeting policy and feedback using oxygen saturation histograms may improve compliance with oxygen targeting.

     

Normal Oxygen Saturation Trend in Healthy Term Newborns within 30 Minutes of Birth

Objective  

To determine normal arterial oxygen saturation (SpO₂) trend during first 30 min of life and to evaluate for difference in SpO₂ trends in healthy term newborns of normal vaginal delivery (NVD) and elective cesarean section (CS).     

Red Cell Enzymes and Intermediates in AGA Term Newborns, AGA Preterm Newborns and SGA Term Newborns

ABSTRACT. Red cell enzyme activities and 2,3-diphosphoglycerate and adenosine-triphosphate levels in cord blood of three groups of newborn infants were studied. The groups were classified according to birthweight in relation to intrauterine growth and gestational age. Only phos-phofructokinase, glyceraldehyde-3-phosphate dehydrogenase and enolase activity values differed significantly among the groups. The activity of phosphofructokinase was lower in small-for-date term infants (TSGA) and preterm adequate for gestational age (PTAGA) in comparison to term infants adequate for gestational age (TAGA). Glyceraldehyde-3-phosphate dehydrogenase activity was higher in TAGA, in comparison to PTAGA, with no other difference among the groups. Enolase activity was found to be higher in TSGA compared to TAGA and higher in PTAGA compared to TAGA. No differences were found between PTAGA and TSGA.     

Anterior Fontanelle Size in Healthy Indian Late Preterm and Full Term Newborns

Objective

To measure the size of the anterior fontanelle (AF) in healthy late-preterm and term newborns and correlate it with birth weight, gestational age, gender, occipito-frontal circumference, small for gestational age status and birth weight z-score.

Methods

This was an observational study carried out from October 2013 through April 2015 at a tertiary care hospital. Newborns?≥?34 wk gestation were enrolled. Fontanelle edge was palpated with index finger and size calculated by adding anterior-posterior and transverse diameters and dividing by two.

Results

A total of 1010 neonates were enrolled. The mean AF size was 2.23?±?0.52 cm (mean?±?SD). There was a significant decrease in the size of the AF with advancing gestational maturity on one-way ANOVA (F?=?31.30) (P?<?0.001) and also by increasing birth weight (F?=?20.34) (P?<?0.001). There was no significant difference in the mean AF size between males; 2.21?±?0.54 cm and females; 2.25?±?0.55 cm (mean?±?SD) (P?=?0.575). There was a strong correlation between AF size with increasing birth weight; correlation (r)?=?0.985. In small for gestational age neonates the AF was larger, 2.27?±?0.55 (mean?±?SD) and a strong correlation between birth weight z-score and AF size was noted (r?=?1.012).

Conclusions

The mean AF size in late-preterm and term Indian newborns in a mixed community hospital was 2.23?±?0.52. A strong correlation was found between AF size with increasing birth weight and with birth weight z-score in small for gestational age babies.