Orgun Leman Tekin, Öztürk Zeynep, Canbeyli Fatma Hayvacı, Yapar Dilek, Gücüyener Kıvılcım, Kula Serdar
Department of Pediatric Neurology, Gazi University Faculty of Medicine, Ankara, Turkey.
Pediatric Neurology Department, Gazi University Faculty of Medicine, 10th Floor Besevler, Ankara, Turkey.
Pediatr Cardiol. 2019 Oct;40(7):1494-1502. doi: 10.1007/s00246-019-02174-4. Epub 2019 Jul 31.
This observational study aimed to investigate the relationship between regional cerebral oxygen saturation (rSO) during the 6-minute walk test (6-MWT) and the demographic/clinical features of patients with pulmonary arterial hypertension (PAH). Cerebral oxygenation was evaluated during the 6-MWT in 20 pediatric patients with PAH aged ≥ 7 years [13 male, 7 female; median age 12.25 (range 7-18) years]. In all patients, regional cerebral oxygen saturation (rSO), arterial oxygen saturation (SpO), and heart rate (HR) were measured using near-infrared spectroscopy (NIRS) for 2 min before the test, during the 6-MWT test, and 2 min after the test. The relationship between the changes in rSO, heart rate, and SpO values and clinical and laboratory features was compared statistically. The mean pulmonary arterial pressure (mPAP) was 77 (range 25-126) mmHg, and the median 6-minute walk distance (6-MWD) was 427.5 (300-570) m. The changes in rSO measurements ranged between 3.41 and 21.8%, and 70% of the patients had a greater than 10% decrease in rSO during the test compared with baseline. Eight patients showed a decrease in rSO without SpO changes. The present study demonstrated a significant decrease in cerebral oxygenation in pediatric patients with PAH during the 6-MWT. We hypothesized that using a combination of the 6-MWT and regional cerebral oxygenation monitoring in pediatric patients with PAH in order to evaluate exercise capacity, as a reflection of reduced daily activities, would provide more precise predictive values than the 6-MWT alone.
这项观察性研究旨在调查6分钟步行试验（6-MWT）期间局部脑氧饱和度（rSO）与肺动脉高压（PAH）患者的人口统计学/临床特征之间的关系。对20例年龄≥7岁的PAH患儿[13例男性，7例女性；中位年龄12.25岁（范围7-18岁）]在6-MWT期间进行脑氧合评估。在所有患者中，使用近红外光谱（NIRS）在试验前2分钟、6-MWT试验期间和试验后2分钟测量局部脑氧饱和度（rSO）、动脉血氧饱和度（SpO）和心率（HR）。对rSO、心率和SpO值的变化与临床和实验室特征之间的关系进行统计学比较。平均肺动脉压（mPAP）为77（范围25-126）mmHg，中位6分钟步行距离（6-MWD）为427.5（300-570）m。rSO测量值的变化范围在3.41%至21.8%之间，70%的患者在试验期间rSO较基线下降超过10%。8例患者rSO下降而SpO无变化。本研究表明，PAH患儿在6-MWT期间脑氧合显著下降。我们假设，对于PAH患儿，联合使用6-MWT和局部脑氧合监测来评估运动能力（作为日常活动减少的反映），将比单独使用6-MWT提供更精确的预测价值。
