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二氧化碳、脑血流与早产儿自动调节之间的关系。

The association between carbon dioxide, cerebral blood flow, and autoregulation in the premature infant.

机构信息

Department of Pediatrics, University of Maryland Baltimore, School of Medicine, Baltimore, MD, USA.

出版信息

J Perinatol. 2021 Feb;41(2):324-329. doi: 10.1038/s41372-020-00835-4. Epub 2020 Oct 8.

DOI:10.1038/s41372-020-00835-4
PMID:33033388
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7542091/
Abstract

OBJECTIVE

Evaluate the association between carbon dioxide (pCO), cerebral blood flow (CBF), and cerebral autoregulation (CA) in preterm infants.

STUDY DESIGN

Cerebral saturations (rScO surrogate for CBF using NIRS) and mean arterial blood pressure (MAP) monitored for 96 h in infants <29 weeks gestation. Relationship between rScO, the rScO-MAP correlation (CA analysis) and pCO category assessed by mixed effects modeling.

RESULTS

Median pCO differed by postnatal day (p < 0.0001)-pCO increased between day 1 and 2, and low variability seen on day 4. A 5% increase in rScO was noted when pCO was >55 mmHg on each postnatal day (p < 0.001). No association observed between the overall rScO-MAP correlation and pCO. On day 1 only, the correlation coefficient decreased from 0.26 to -0.09 as pCO category increased (p = 0.02).

CONCLUSIONS

CBF increased above a pCO threshold of 55 mmHg, but overall, no association between pCO and CA was noted.

摘要

目的

评估二氧化碳（pCO）、脑血流（CBF）和脑自动调节（CA）在早产儿中的关联。

研究设计

对胎龄<29 周的婴儿进行 96 小时的脑饱和度（使用近红外光谱法的 rScO 替代 CBF）和平均动脉血压（MAP）监测。通过混合效应模型评估 rScO、rScO-MAP 相关性（CA 分析）与 pCO 类别的关系。

结果

pCO 在出生后第 1 天至第 2 天之间增加，第 4 天变化较小，中位数 pCO 按出生后天数不同（p<0.0001）。在出生后的每一天，当 pCO 超过 55mmHg 时，rScO 增加了 5%（p<0.001）。在整体 rScO-MAP 相关性和 pCO 之间未观察到任何关联。仅在第 1 天，随着 pCO 类别的增加，相关系数从 0.26 降至-0.09（p=0.02）。

结论

当 pCO 超过 55mmHg 时，CBF 增加，但总体而言，pCO 和 CA 之间没有关联。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a4ff/7542091/1e0ba2f75426/41372_2020_835_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a4ff/7542091/d45ed51a9c14/41372_2020_835_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a4ff/7542091/8df13d1d6653/41372_2020_835_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a4ff/7542091/a399ba1dbbcc/41372_2020_835_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a4ff/7542091/1e0ba2f75426/41372_2020_835_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a4ff/7542091/d45ed51a9c14/41372_2020_835_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a4ff/7542091/8df13d1d6653/41372_2020_835_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a4ff/7542091/a399ba1dbbcc/41372_2020_835_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a4ff/7542091/1e0ba2f75426/41372_2020_835_Fig4_HTML.jpg

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