Zaramella Patrizia, Freato Federica, Quaresima Valentina, Ferrari Marco, Bartocci Marco, Rubino Maurizio, Falcon Elena, Chiandetti Lino
Department of Paediatrics, Neonatal Intensive Care Unit, University of Padova, Padova, Italy.
Pediatr Int. 2006 Jun;48(3):305-12. doi: 10.1111/j.1442-200X.2006.02209.x.
The aim of this study was to investigate the effects of patent ductus arteriosus (PDA) ligature on cerebral oxygen saturation, cerebral blood volume (CBV) and cerebral blood flow velocity by means of near-infrared spectroscopy (NIRS) and transcranial Doppler simultaneous examinations.
This is an observational study considering 16 babies of gestational age 24-34 weeks diagnosed with PDA who underwent surgical ligation. The cerebral oxygen saturation, CBV and blood gases values were obtained 35 min before ligation, so also around the 14th and 27th min after the clip's insertion.
Cerebral oxygen saturation, measured as tissue oxygenation index (TOI), decreased significantly after PDA ligation from a basal value of 61.1 (3.8) before surgery to 56.6 (3.3) and 55.8 (2.6)%, for the 14th and 27th min, respectively (P<0.04). CBV before and after clipping was unvaried. A negative correlation was found between DeltapH and DeltaCBV after ligation (R=0.52, P=0.03), whilst a positive correlation was found between DeltaCBV and DeltaP(aCO2) (R=0.62, P=0.009). pH increased at the 27th min post-ligation.
NIRS is a tool for obtaining information on cerebral oxygen saturation and CBV changes during surgical PDA ligation at the bedside. A fall in TOI suggests an increased oxygen extraction during PDA surgery. The lack of increase in DeltaCBV or in diastolic flow velocity show that the PDA before the clipping did not limit cerebral blood flow, the drop in TOI suggests increased oxygen consumption over the clip and the need for accurate monitoring of oxygen utilization after the surgical treatment.
本研究旨在通过近红外光谱（NIRS）和经颅多普勒同步检查，探讨动脉导管未闭（PDA）结扎对脑氧饱和度、脑血容量（CBV）和脑血流速度的影响。
这是一项观察性研究，纳入了16例孕周为24 - 34周、诊断为PDA并接受手术结扎的婴儿。在结扎前35分钟、夹子插入后约14分钟和27分钟时获取脑氧饱和度、CBV和血气值。
以组织氧合指数（TOI）衡量的脑氧饱和度在PDA结扎后显著下降，术前基础值为61.1（3.8）%，在第14分钟和第27分钟时分别降至56.6（3.3）%和55.8（2.6）%（P<0.04）。夹闭前后CBV无变化。结扎后DeltapH与DeltaCBV之间呈负相关（R = 0.52，P = 0.03），而DeltaCBV与DeltaP(aCO2)之间呈正相关（R = 0.62，P = 0.009）。结扎后第27分钟时pH升高。
NIRS是一种在床边手术结扎PDA期间获取脑氧饱和度和CBV变化信息的工具。TOI下降表明PDA手术期间氧摄取增加。DeltaCBV或舒张期血流速度未增加表明夹闭前的PDA并未限制脑血流，TOI下降表明夹闭后氧消耗增加，以及手术治疗后需要准确监测氧利用情况。
