利用心率或血压评估早产儿脑血管自动调节功能的初步研究
Cerebrovascular Autoregulation in Preterm Infants Using Heart Rate or Blood Pressure: A Pilot Study.
作者信息
Lahr Bineta E, Brunsch Celina L, Dikkers Riksta, Bos Arend F, Kooi Elisabeth M W
机构信息
Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands.
Department of Pediatric Radiology, Beatrix Children's Hospital, University Medical Center of Groningen, 9713 GZ Groningen, The Netherlands.
出版信息
Children (Basel). 2024 Jun 24;11(7):765. doi: 10.3390/children11070765.
BACKGROUND
Cerebrovascular autoregulation (CAR) is often impaired in preterm infants but requires invasive mean arterial blood pressure (MABP) measurements for continuous assessment. We aimed to assess whether using heart rate (HR) results in different CAR assessment compared with using MABP.
METHODS
We compared CAR (moving window correlation-coefficient with cerebral oxygenation saturation (rSO)), and percentage of time with impaired CAR (%timeCARi) calculated by either HR (TOHRx, tissue oxygenation heart rate reactivity index) or MABP (COx, cerebral oximetry index) during the first 72 h after birth, and its association with short-term cerebral injury.
RESULTS
We included 32 infants, median gestational age of 25 + 5/7 weeks (interquartile range 24 + 6/7-27 + 5/7). COx and TOHRx correlation coefficients (cc) were significantly different in the first two days after birth (individual means ranging from 0.02 to 0.07 and -0.05 to 0.01). %TimeCARi using MABP (cc cut-off 0.3), was higher on day 1 (26.1% vs. 17.7%) and day 3 (23.4% vs. 16.9%) compared with HR (cc cutoff -0.3). During 65.7-69.6% of the time, both methods indicated impaired CAR simultaneously. The aforementioned calculations were not associated with early cerebral injury.
CONCLUSIONS
In conclusion, HR and MABP do not seem interchangeable when assessing CAR in preterm infants.
背景
脑血管自动调节功能（CAR）在早产儿中常受损，但需要通过有创测量平均动脉血压（MABP）来进行连续评估。我们旨在评估与使用MABP相比，使用心率（HR）进行CAR评估是否会得出不同结果。
方法
我们比较了出生后72小时内通过HR（TOHRx，组织氧合心率反应指数）或MABP（COx，脑氧饱和度指数）计算的CAR（与脑氧饱和度的移动窗口相关系数（rSO））以及CAR受损时间百分比（%timeCARi），并分析其与短期脑损伤的关联。
结果
我们纳入了32例婴儿，中位胎龄为25 + 5/7周（四分位间距24 + 6/7 - 27 + 5/7）。出生后头两天COx和TOHRx的相关系数（cc）有显著差异（个体均值范围分别为0.02至0.07和 -0.05至0.01）。与HR（cc截止值 -0.3）相比，使用MABP（cc截止值0.3）计算的%timeCARi在第1天（26.1%对17.7%）和第3天（23.4%对16.9%）更高。在65.7 - 69.6%的时间里，两种方法均显示CAR受损。上述计算结果与早期脑损伤无关。
结论
总之，在评估早产儿CAR时，HR和MABP似乎不可互换。
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