早产儿早期过渡循环期间血液动力学、脑氧合和脑血管反应性的变化。
Changes in hemodynamics, cerebral oxygenation and cerebrovascular reactivity during the early transitional circulation in preterm infants.
机构信息
Neonatal Unit, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Department of Anesthesiology, Pharmacology and Therapeutics, University of British, Columbia, Vancouver, Canada.
出版信息
Pediatr Res. 2019 Aug;86(2):247-253. doi: 10.1038/s41390-019-0410-z. Epub 2019 Apr 27.
BACKGROUND
Changes in systemic and cerebral hemodynamics in preterm infants during early transitional circulation are complex and may differ between infants with or without intraventricular hemorrhage (IVH).
METHOD
In total, 43 infants born at median (range) 25 + 5 (23 + 3-31) had continuous near-infrared spectroscopy (NIRS) monitoring of tissue oxygenation index (TOI) and cerebrovascular reactivity within the first 48 h of life. Measurements of left and right cardiac outputs (LVO, RVO) and patent ductus arteriosus (PDA) were collected at 6, 12, 24, and 48 h of life.
RESULTS
LVO increased within the first 48 h in the IVH (P = 0.007) and no-IVH (P < 0.001) groups. The pattern of change in LVO and RVO was not different between these two groups. TOI was lower in the IVH (P < 0.001) group. A positive correlation between TOI and LVO (P = 0.003) and a negative correlation between the tissue oxygen reactivity index (TOx) and LVO (P = 0.04) were observed at 24 h of life in the IVH group. PDA diameter was not different between IVH groups at any time interval.
CONCLUSION
Cerebral oxygenation was lower and cerebrovascular reactivity was passive to systemic blood flow at 24 h in infants who developed an IVH.
背景
早产儿在早期过渡循环期间全身和脑血流动力学的变化是复杂的，并且可能因有无脑室出血（IVH）的婴儿而有所不同。
方法
共有 43 名出生时中位数（范围）为 25+5（23+3-31）的婴儿在生命的头 48 小时内进行了组织氧合指数（TOI）和脑血管反应性的连续近红外光谱（NIRS）监测。在生命的第 6、12、24 和 48 小时测量左心输出量（LVO）和右心输出量（RVO）和动脉导管未闭（PDA）。
结果
IVH（P=0.007）和非 IVH（P<0.001）组在生命的前 48 小时内 LVO 增加。这两组之间 LVO 和 RVO 变化的模式没有差异。TOI 在 IVH 组中较低（P<0.001）。在 IVH 组中，在生命的第 24 小时观察到 TOI 与 LVO 之间存在正相关（P=0.003），以及组织氧反应指数（TOx）与 LVO 之间的负相关（P=0.04）。在任何时间间隔，IVH 组之间的 PDA 直径均无差异。
结论
在发生 IVH 的婴儿中，在 24 小时时脑氧合较低，并且脑血管反应性对全身血流呈被动状态。
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