Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium. joke.vanderhaegen @ uz.kuleuven.ac.be
Neonatology. 2010 Jun;98(1):57-63. doi: 10.1159/000271224. Epub 2009 Dec 24.
To assess variability of systemic hemodynamics and its covariates following bolus propofol administration in (pre)term neonates, and to analyze the effect of propofol on cerebral tissue oxygenation index (TOI) and fractional tissue oxygen extraction measured by near-infrared spectroscopy.
In (pre)term neonates, we recorded mean arterial blood pressure (MABP), saturation (SaO(2)), heart rate (HR) and TOI from 5 min before up to 60 min after intravenous bolus propofol (3 mg kg(-1)) administration during elective chest tube removal. Covariate analysis included postmenstrual age (PMA <or= or >37 weeks), postnatal age (PNA <or= or >10 days), comedication (fentanyl +/- midazolam) and congenital cardiopathy (yes/no). Fractional tissue oxygen extraction was calculated as (SaO(2) - TOI)/SaO(2).
Twenty recordings in 19 neonates were assessed. Following propofol administration, an abrupt, minor decrease in HR and SaO(2) was seen with fast recovery, while MABP decreased up to 1 h. TOI decreased during the first 3 min, reflecting an imbalance between cerebral oxygen delivery and demand. Despite sustained decrease in MABP, TOI then returned to baseline, suggesting a better balance between oxygen delivery and demand. PNA <or=10 days, comedication and absence of cardiopathy were associated with more subtle decreases in cerebral oxygenation and faster recovery.
Propofol-induced decrease in HR, SaO(2) and cerebral oxygenation is short lasting while a decrease in MABP is observed up to 60 min. The variability in the effects of propofol is influenced by PNA, comedication or cardiopathy. Near-infrared spectroscopy can be used to assess hemodynamic effects of hypnotics on the cerebral oxygenation.
评估早产儿和（或）足月新生儿单次推注丙泊酚后全身血流动力学的变化及其影响因素，并分析丙泊酚对脑氧合指数（TOI）和近红外光谱测量的局部组织氧提取分数的影响。
选择需行胸腔引流管拔管的早产儿和（或）足月新生儿，于静脉推注丙泊酚（3mg/kg）前 5min 至给药后 60min，记录平均动脉压（MABP）、饱和度（SaO2）、心率（HR）和 TOI。采用协方差分析方法，对影响血流动力学的因素（胎龄<37 周或≥37 周、生后年龄<10 天或≥10 天、联合使用芬太尼和/或咪达唑仑、有无先天性心脏病）进行分析。局部组织氧提取分数为（SaO2-TOI）/SaO2。
本研究共纳入 19 例新生儿 20 次记录。静脉推注丙泊酚后，即刻出现短暂的 HR 和 SaO2 下降，随后快速恢复，而 MABP 下降持续 1h。TOI 在最初 3min 内逐渐下降，提示脑氧供与氧需失衡。尽管 MABP 持续下降，但 TOI 随后恢复至基线，提示氧供与氧需恢复平衡。生后年龄<10 天、联合使用芬太尼和/或咪达唑仑、无先天性心脏病与脑氧合更明显的下降和更快的恢复相关。
丙泊酚诱导的 HR、SaO2 和脑氧合下降持续时间短暂，而 MABP 下降可持续至给药后 60min。丙泊酚的作用存在个体差异，其影响因素包括生后年龄、联合用药或先天性心脏病。近红外光谱可用于评估镇静药物对脑氧合的血流动力学效应。
