Ercan Gözde, Imamoglu Ebru Y, Şahin Özlem, Çolak Derya, Imamoglu Serhat
Department of Pediatrics, Faculty of Health Sciences, Sancaktepe Prof Ilhan Varank Training and Research Hospital, İstanbul, Turkey.
Department of Neonatology, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul Medeniyet University, Istanbul, Turkey.
Am J Perinatol. 2024 May;41(S 01):e1330-e1336. doi: 10.1055/a-2016-7502. Epub 2023 Jan 20.
This study aimed to evaluate the effect of peripherally inserted central venous catheterization on cerebral oxygenation by near-infrared spectroscopy in very low birth weight preterm infants.
Forty-one preterm infants (gestational age ≤32 weeks and birth weight ≤1,500 g) requiring peripherally inserted central venous catheter were included. Hemodynamic data and cerebral regional oxygen saturation values measured by near-infrared spectroscopy were prospectively collected before (T0) and every 5 minutes for 30 minutes following catheterization. When compared with baseline (T0) values, those values having relative maximum changes in the first 15 minutes and between 15 and 30 minutes were defined as T15 max and T30 max, respectively. Any change of more than a 10% decrease in baseline cerebral rSO was considered clinically significant. Additionally, any changes exceeding 20% in heart rate and mean arterial blood pressure values were considered significant. Following catheterization, the time interval to reach the baseline for cerebral regional oxygen saturation was noted.
Cerebral regional oxygen saturation values at T15 max and T30 max were found to have decreased significantly in 46 and 22% of patients, respectively. A statistically significant difference was observed between these two time periods ( = 0.002); no significant differences in heart rate, mean arterial blood pressure, or cerebral fractional oxygen extraction values at T15 max and T30 max were observed. All patients reached their baseline cerebral regional oxygen saturation in a median of 25 (15-60) minutes.
In very low birth weight preterm infants, monitoring cerebral regional oxygen saturation by near-infrared spectroscopy before and after peripherally inserted central venous catheterization may be useful in clinical practice. The assessment of factors affecting cerebral oxygenation and, in the case of low cerebral oxygenation, implementation of corrective actions before peripherally inserted central catheterization may offer a neuroprotective strategy.
· Monitoring cerebral rSO2 by NIRS during PICC line procedure might be useful in preterm infants.. · In this study, a significant decrease in cerebral rSO2 level following catheterization was observed.. · Implementation of corrective actions before PICC line procedure may offer a neuroprotective strategy..
本研究旨在通过近红外光谱法评估外周静脉穿刺中心静脉置管术对极低出生体重早产儿脑氧合的影响。
纳入41例需要外周静脉穿刺中心静脉置管的早产儿（胎龄≤32周，出生体重≤1500g）。前瞻性收集置管前（T0）以及置管后30分钟内每5分钟通过近红外光谱法测量的血流动力学数据和脑局部氧饱和度值。与基线（T0）值相比，在最初15分钟内以及15至30分钟之间具有相对最大变化的值分别定义为T15 max和T30 max。基线脑rSO下降超过10%的任何变化被认为具有临床意义。此外，心率和平均动脉血压值超过20%的任何变化被认为是显著的。置管后，记录脑局部氧饱和度达到基线的时间间隔。
分别有46%和22%的患者在T15 max和T30 max时脑局部氧饱和度值显著下降。在这两个时间段之间观察到统计学上的显著差异（P = 0.002）；在T15 max和T30 max时，心率、平均动脉血压或脑氧摄取分数值没有显著差异。所有患者脑局部氧饱和度中位数在25（15 - 60）分钟内恢复到基线水平。
在极低出生体重早产儿中，在外周静脉穿刺中心静脉置管术前后通过近红外光谱法监测脑局部氧饱和度在临床实践中可能有用。评估影响脑氧合的因素，并且在脑氧合降低的情况下，在外周中心静脉置管术前采取纠正措施可能提供一种神经保护策略。
· 在经外周静脉穿刺中心静脉导管置管术（PICC）过程中通过近红外光谱法监测脑rSO2可能对早产儿有用。· 在本研究中，观察到置管后脑rSO2水平显著下降。· 在PICC置管术前采取纠正措施可能提供一种神经保护策略。
