Department of Neonatology, University Hospitals Leuven, Leuven, Belgium.
Department of Electrical Engineering, ESAT-Stadius, KU Leuven, Leuven, Belgium.
Pediatr Res. 2018 Nov;84(5):719-725. doi: 10.1038/s41390-018-0160-3. Epub 2018 Sep 10.
Despite increasing use of propofol in neonates, observations on cerebral effects are limited.
To investigate cerebral autoregulation (CAR) and activity after propofol for endotracheal intubation in preterm neonates.
Twenty-two neonates received propofol before intubation as part of a published dose-finding study. Mean arterial blood pressure (MABP), near-infrared spectroscopy-derived cerebral oxygenation (rScO), and amplitude-integrated electroencephalography (aEEG) were analyzed until 180 min after propofol. CAR was expressed as transfer function (TF) gain, indicating % change in rScO per 1 mmHg change in MABP. Values exceeding mean TF gain + 2 standard deviations (SD) defined impaired CAR.
After intubation with a median propofol dose of 1 (0.5-4.5) mg/kg, rScO remained stable during decreasing MABP. Mean (±SD) TF gain was 0.8 (±0.3)%/mmHg. Impaired CAR was identified in 1 and 5 patient(s) during drug-related hypotension and normal to raised MABP, respectively. Suppressed aEEG was observed up to 60 min after propofol.
Drug-related hypotension and decreased cerebral activity after intubation with low propofol doses in preterm neonates were observed, without evidence of cerebral ischemic hypoxia. CAR remained intact during drug-related hypotension in 95.5% of patients. Cerebral monitoring including CAR clarifies the cerebral impact of MABP fluctuations.
尽管在新生儿中越来越多地使用丙泊酚，但对其脑效应的观察是有限的。
研究丙泊酚用于早产儿气管插管时的脑自动调节（CA R）和脑活动。
22 名新生儿在插管前接受了丙泊酚治疗，这是一项已发表的剂量发现研究的一部分。平均动脉血压（MABP）、近红外光谱衍生的脑氧饱和度（rScO）和振幅整合脑电图（aEEG）一直分析到丙泊酚后 180 分钟。CA R 用传递函数（TF）增益表示，指示 rScO 每变化 1mmHg 与 MABP 的变化百分比。超过平均 TF 增益+2 个标准差（SD）的值定义为 CA R 受损。
在接受中位数为 1（0.5-4.5）mg/kg 的丙泊酚剂量插管后，rScO 在 MABP 降低期间保持稳定。平均（±SD）TF 增益为 0.8（±0.3）%/mmHg。在与药物相关的低血压期间，1 名患者（s）和在正常至升高的 MABP期间，分别有 5 名患者（s）出现 CA R 受损。在丙泊酚后，aEEG 被抑制了长达 60 分钟。
在接受低剂量丙泊酚插管后，观察到早产儿与药物相关的低血压和脑活动减少，但没有脑缺血缺氧的证据。在与药物相关的低血压期间，95.5%的患者 CA R 保持完整。包括 CA R 的脑监测可阐明 MABP 波动对脑的影响。
