局部脑氧饱和度和肠道血氧饱和度对新生儿坏死性小肠结肠炎早期预警及手术治疗时机的指导价值

目的 研究局部脑氧饱和度(rcSO₂)和局部肠道血氧饱和度(rintSO₂)与新生儿坏死性小肠结肠炎(NEC)病情程度的关系，探讨rcSO₂和rintSO₂对NEC早期预警及手术干预时机的指导意义。方法 回顾性分析2021年3月至8月96例胎龄<32周早产儿临床资料，根据是否发生NEC分为三组：对照组49例，未发生NEC；疑似组14例，疑似发生NEC;NEC组33例，患有NEC。其中NEC组再根据是否手术分为两个亚组：手术组19例，非手术组14例。观察三组不同临床分期早产儿的rcSO₂和rintSO₂水平变化，Spearman相关性分析其与Bell分期的关系；利用受试者工作特征(ROC)曲线分析rcSO₂、rintSO₂预测NEC发生和手术时机的价值。结果 (1)疑似组和NEC组rcSO₂及不同监测部位rintSO₂水平均较对照组明显降低，NEC组降低幅度较为显著...

Regional cerebral oxygen saturation and regional intestinal oxygen saturation in early warning and surgical treatment of neonatal necrotizing enterocolitis

ObjectiveTo study the performance of regional cerebral oxygen saturation (rcSO₂) and regional intestinal oxygen saturation (rintSO₂) in the neonates with different stages of necrotizing enterocolitis (NEC), and to explore the significance in the early warning of NEC and the timing of surgical intervention. MethodsThe clinical data of 96 premature infants with gestational age <32 weeks from March to August 2021 were retrospectively analyzed. According to the occurrence of NEC, they were divided into three groups: 49 infants without NEC in the control group; 14 infants in the suspected group were suspected of NEC; 33 infants in NEC group were diagnosed with NEC. Infants in the NEC group were divided into two subgroups according to whether surgery was performed, with 19 infants in the operation group and 14 in the non-operation group. To observe the changes of rcSO₂ and rintSO₂ levels in the three groups of preterm infants with different clinical stages, Spearman correlation analysis of the relationship between them and Bell staging was carried out. Receiver operating characteristics (ROC) curve was used to analyze the value of rcSO₂ and rintSO₂ in predicting the occurrence of NEC and the timing of surgery. Results(1) rcSO₂ levels in the suspected group and NEC group and rintSO₂ levels in different monitoring sites were significantly lower than those in control group, and the decrease range was significantly higher in NEC group (F=19.952-43.865, P<0.05). RcSO₂ and rintSO₂ levels in different monitoring sites decreased gradually with the increase of Bell staging (F=5.298-12.866, P<0.05), and were negatively correlated with Bell staging (P<0.05). When rcSO₂<74.3% and right abdominal rintSO₂<75.4%, the area under curvec (AUC) of NEC and rintSO₂ were 0.836 and 0.817 respectively, and the corresponding sensitivity and specificity were 78.8%, 84.8% and 81.8%, 76.9%, respectively, indicating high diagnostic efficiency. (2) RcSO₂ and rintSO₂ levels in different monitoring sites in operation group were significantly lower than those in non-operation group (t=2.341-4.815, P<0.05). When rcSO₂<72.4% and right abdominal rintSO₂<71.5%, the AUC values for predicting surgical intervention of NEC were 0.755 and 0.729, respectively, and the corresponding sensitivity and specificity were 71.6%, 79.4% and 75.8%, 66.7% respectively, indicating high diagnostic efficiency. ConclusionsThe changes of rcSO₂ and rintSO₂ levels are closely related to the severity of NEC in neonates. The application of near-infrared spectroscopy technology to monitor rcSO₂ and rintSO₂ levels has certain guiding value for early warning NEC and guiding the timing of surgical intervention.