经近红外光谱仪测量，极低出生体重儿动脉导管未闭的治疗对脑肾组织氧合的影响。
Impact of Medical Treatment of Hemodynamically Significant Patent Ductus Arteriosus on Cerebral and Renal Tissue Oxygenation Measured by Near-Infrared Spectroscopy in Very Low-Birth-Weight Infants.
机构信息
Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-08406 Vilnius, Lithuania.
Department of Mechanical and Material Engineering, Vilnius Gediminas Technical University, LT-10223 Vilnius, Lithuania.
出版信息
Medicina (Kaunas). 2022 Mar 25;58(4):475. doi: 10.3390/medicina58040475.
Background and objective: Hemodynamically significant patent ductus arteriosus (hsPDA) can cause ductal steal and contribute to poor outcomes in preterm infants. Near-infrared spectroscopy (NIRS) allows us to continuously evaluate regional tissue oxygenation (rSpO2) and perfusion changes in underlying organs. The aim of this study was to evaluate the effect of medical treatment for hsPDA on cerebral and renal rSpO2 in infants less than 32 weeks of gestational age, and older than 72 h of life. Materials and methods: Infants with a gestational age of <32 weeks with hsPDA were prospectively studied before and during medical treatment. Two-site (cerebral and renal) rSpO2 monitoring by NIRS was performed 1 h before treatment (T0) and 24 h (T1), 24−48 h (T2), 48−72 h (T3) after the infusion of the first drug dose. Results: A total of 21 infants were studied. The mean day of life at treatment initiation was 8.2 (SD, 2.75). The DA diameter, LA/Ao ratio, and resistive index in the anterior cerebral artery (RI ACA) were significantly lower after treatment (p < 0.05). There were no significant differences in cerebral rSpO2, cerebral fractional tissue oxygen extraction (FTOE), and SpO2 comparing different time points. A significantly higher renal SpO2 value was recorded at T2 as compared with T0 (75.0%, SD 4.9%, vs. 69.4%, SD 7.6%; p < 0.013), while for renal FTOE, a tendency to lower values at T2 was observed (0.18, SD 0.05, vs. 0.24, SD 0.09; p = 0.068). Conclusions: Late (later than 7 days postpartum) hsPDA medical treatment with paracetamol or ibuprofen completely closed the duct only in a small proportion of preterm infants, despite a statistically significant reduction in the DA diameter, LA/Ao ratio, and RI ACA. Continuous renal, not cerebral, NIRS measurements can help to anticipate the efficacy of medical treatment of hsPDA in preterm infants. Large-scale prospective studies are needed to ascertain that renal and cerebral NIRS can be used as a reliable tool for evaluating the effectiveness of medical treatment for hsPDA.
背景与目的
血流动力学显著的动脉导管未闭（hsPDA）可导致导管窃血，并导致早产儿预后不良。近红外光谱（NIRS）可连续评估潜在器官的局部组织氧合（rSpO2）和灌注变化。本研究旨在评估小于 32 周胎龄和大于 72 小时的 hsPDA 患儿药物治疗对大脑和肾脏 rSpO2 的影响。
材料与方法
前瞻性研究胎龄<32 周、hsPDA 的患儿，在治疗前和治疗期间进行双部位（大脑和肾脏）NIRS rSpO2 监测。在首次药物剂量输注前 1 小时（T0）和 24 小时（T1）、24−48 小时（T2）、48−72 小时（T3）进行。
结果
共纳入 21 例患儿。治疗开始时的平均日龄为 8.2（标准差，2.75）。治疗后，动脉导管直径、左心房/主动脉比值和大脑前动脉阻力指数（RI ACA）显著降低（p<0.05）。不同时间点的大脑 rSpO2、大脑部分组织氧摄取分数（FTOE）和 SpO2 无显著差异。与 T0 相比，T2 时肾 SpO2 值显著升高（75.0%，标准差 4.9%，vs. 69.4%，标准差 7.6%；p<0.013），而肾 FTOE 则有降低趋势（0.18，标准差 0.05，vs. 0.24，标准差 0.09；p=0.068）。
结论
晚发型（产后 7 天以上）hsPDA 患儿使用对乙酰氨基酚或布洛芬药物治疗，尽管动脉导管直径、左心房/主动脉比值和大脑前动脉 RI ACA 均有统计学意义的降低，但只有一小部分患儿的动脉导管完全关闭。连续的肾脏而不是大脑 NIRS 测量有助于预测早产儿 hsPDA 药物治疗的效果。需要进行大规模的前瞻性研究以确定肾和脑 NIRS 可作为评估 hsPDA 药物治疗效果的可靠工具。
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