接受治疗性低体温治疗的新生儿脑氧饱和度与脑损伤的相关性。
Association between cerebral oxygen saturation and brain injury in neonates receiving therapeutic hypothermia for neonatal encephalopathy.
机构信息
Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
1st Department of Pediatrics, Semmelweis University, Budapest, Hungary.
出版信息
J Perinatol. 2021 Feb;41(2):269-277. doi: 10.1038/s41372-020-00910-w. Epub 2021 Jan 18.
OBJECTIVE
To assess the association of cerebral oxygen saturation (CrSO) collected by near infrared spectroscopy (NIRS) during therapeutic hypothermia (TH) and rewarming with evidence of brain injury on post-rewarming MRI.
STUDY DESIGN
This retrospective cohort study included 49 infants, who received TH for mild to severe neonatal encephalopathy. Of those, 26 presented with brain injury assessed by a novel MRI grading system, whereas 23 had normal MRI scans.
RESULTS
CrSO increased significantly from the first to the second day of TH in infants with brain injury, whereas it remained stable in patients with normal MRI. Increasing mean CrSO values during rewarming was associated with brain injury (aOR 1.14; 95% CI 1.00-1.28), specifically with gray matter (GM) injury (aOR 1.23; 95% CI 1.02-1.49). The area under the ROC curve showed an excellent discrimination for GM involvement.
CONCLUSION
Clinically applied NIRS during TH and rewarming can assist in identifying the risk for brain injury.
目的
评估近红外光谱（NIRS）在治疗性低温（TH）和复温期间采集的脑氧饱和度（CrSO）与复温后 MRI 上脑损伤证据之间的关联。
研究设计
本回顾性队列研究纳入了 49 名接受 TH 治疗的轻度至重度新生儿脑病的婴儿。其中，26 名婴儿通过新的 MRI 分级系统评估存在脑损伤，而 23 名婴儿 MRI 扫描正常。
结果
在 MRI 显示脑损伤的婴儿中，CrSO 在 TH 的第一天到第二天之间显著增加，而在 MRI 正常的婴儿中，CrSO 保持稳定。复温期间平均 CrSO 值的增加与脑损伤相关（OR 1.14；95%CI 1.00-1.28），特别是与灰质（GM）损伤相关（OR 1.23；95%CI 1.02-1.49）。ROC 曲线下面积显示出对 GM 受累的出色鉴别能力。
结论
TH 和复温期间临床应用的 NIRS 可辅助识别脑损伤风险。
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