早产儿动脉导管未闭手术结扎时脑氧供是否受影响？
Is cerebral oxygen supply compromised in preterm infants undergoing surgical closure for patent ductus arteriosus?
机构信息
Department of Neonatology, University Medical Center/Wilhelmina Children's Hospital, Utrecht, The Netherlands.
出版信息
Arch Dis Child Fetal Neonatal Ed. 2010 Nov;95(6):F429-34. doi: 10.1136/adc.2009.180117. Epub 2010 Jun 28.
BACKGROUND
A haemodynamically important patent ductus arteriosus (PDA) is a risk factor for brain damage in preterm infants. The authors previously reported lower regional cerebral oxygen saturation (rScO(2)) in infants with PDA, which recovered after administration of indomethacin. However, PDA ligation has been reported to pose an even higher risk of neurodevelopmental impairment.
OBJECTIVE
To investigate the impact of surgical closure of PDA on rScO(2) and cerebral fractional tissue oxygen extraction (cFTOE), measured by near-infrared spectroscopy, and on amplitude-integrated electro-encephalography (aEEG) measured brain activity.
DESIGN/METHODS: In 20 preterm infants (gestational age 24.7-30.4 weeks; birth weight 630-1540 g), blood pressure, arterial saturation, rScO(2), cFTOE and aEEG were monitored before, during and up to 24 h after surgery.
RESULTS
Before surgery, median (range) rScO(2) was 53% (41-68%), and during surgery, but before ductal clipping, it was 46% (31-89%). Eleven infants showed a drop in blood pressure and 13 infants a drop in rScO(2) during surgery (range 2-21%), accompanied by a decrease in aEEG amplitude. Twelve infants had rScO(2) values below 50% during surgery, with five being below 40%. Only at 24 h after surgery was rScO(2) higher (61% (36-85%), p<0.05) and cFTOE values lower (0.38 (0.09-0.61); p<0.05) compared with preclipping values.
CONCLUSION
Ductal ligation poses a risk for a further decrease in already compromised cerebral oxygenation in preterm infants.
背景
在早产儿中，血流动力学重要的动脉导管未闭（PDA）是脑损伤的危险因素。作者先前报道了患有 PDA 的婴儿局部脑氧饱和度（rScO2）较低，在使用吲哚美辛后恢复。然而，已经有报道称动脉导管结扎术甚至会增加神经发育损伤的风险。
目的
通过近红外光谱测量局部脑氧饱和度（rScO2）和脑局部组织氧摄取分数（cFTOE），以及振幅整合脑电图（aEEG）测量脑活动，探讨动脉导管结扎术对 rScO2 和 cFTOE 的影响。
方法
在 20 名早产儿（胎龄 24.7-30.4 周；出生体重 630-1540 克）中，在手术前、手术中和手术后 24 小时内监测血压、动脉饱和度、rScO2、cFTOE 和 aEEG。
结果
手术前 rScO2 的中位数（范围）为 53%（41-68%），而在手术中但在动脉导管夹闭前，rScO2 为 46%（31-89%）。11 名婴儿在手术期间出现血压下降，13 名婴儿 rScO2 下降（范围 2-21%），同时 aEEG 幅度降低。12 名婴儿在手术期间 rScO2 值低于 50%，其中 5 名婴儿低于 40%。只有在手术后 24 小时，rScO2 才升高（61%（36-85%），p<0.05），cFTOE 值降低（0.38（0.09-0.61）；p<0.05）与夹闭前值相比。
结论
动脉导管结扎术会增加早产儿已经受损的脑氧合进一步下降的风险。
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