近红外光谱技术对有血流动力学意义的动脉导管未闭早产儿肠道组织氧饱和度监测价值的前瞻性研究  

Value of near-infrared spectroscopy in monitoring intestinal tissue oxygen saturation in preterm infants with hemodynamically significant patent ductus arteriosus:a prospective research

作　　者：黄循斌[1] 钟晓[1] 刘婷[1] 程国强 丘惠娴[1] HUANG Xun-Bin;ZHONG Xiao;LIU Ting;CHENG Guo-Qiang;QIU Hui-Xian(Department of Neonatology,Longgang District Central Hospital of Shenzhen,Shenzhen,Guangdong 518116,China;不详)

机构地区：[1]深圳市龙岗中心医院新生儿科,广东深圳518116 [2]复旦大学附属儿科医院新生儿科,上海201102

出　　处：《中国当代儿科杂志》2021年第8期821-827,共7页Chinese Journal of Contemporary Pediatrics

摘　　要：目的使用近红外光谱技术研究有血流动力学意义的动脉导管未闭(hemodynamically significant patent ductusarteriosus,hsPDA)早产儿肠道组织氧饱和度(regional oxygensaturation,rSO_(2))的变化及规律,初步探索hsPDA早产儿肠道组织血氧水平变化的临床意义。方法前瞻性选取2017年10月至2020年10月深圳市龙岗中心医院新生儿科收治的胎龄<32周和/或出生体重<1500 g的动脉导管未闭(patent ductusarteriosus,PDA)早产儿。按照hsPDA的诊断标准分为hsPDA组和无血流动力学意义的动脉导管未闭(non-hemodynamically significant patentductusarteriosus,nhsPDA)组,将hsPDA组早产儿根据口服布洛芬后动脉导管关闭情况分为hsPDA关闭亚组和hsPDA未闭亚组。分别在诊断PDA时及治疗后测定血流动力学指标,持续监测患儿肠道组织rSO_(2)水平,分析其变化规律。结果共有241例PDA早产儿纳入研究,其中hsPDA组55例(22.8%),nhsPDA组186例(77.2%);hsPDA关闭亚组36例(65%),hsPDA未闭亚组19例(35%)。hsPDA组左心房内径/主动脉根部内径值大于nhsPDA组,左室射血分数和短轴缩短率均低于nhsPDA组(P<0.05)。hsPDA组患儿肠道组织rSO_(2)在诊断后6 h内各时间点(1、2、4、6 h)均低于nhsPDA组(P<0.05);hsPDA组早产儿肠道组织rSO_(2)随时间呈下降趋势(P<0.05),至6 h时达最低值(0.448±0.014)。hsPDA关闭亚组左心房内径/主动脉根部内径值低于hsPDA未闭亚组,左室射血分数和短轴缩短率高于hsPDA未闭亚组(P<0.05)。hsPDA关闭亚组患儿肠道组织rSO_(2)在治疗后48~96 h内各时间点(48、72、96 h)均高于hsPDA未闭亚组(P<0.05);hsPDA关闭亚组早产儿肠道组织rSO_(2)从治疗24 h后随时间呈上升趋势(P<0.05),至96 h达最高值(0.578±0.031)。结论hsPDA对早产儿肠道组织氧合有影响,可通过近红外光谱技术持续监测hsPDA早产儿肠道组织rSO_(2)变化趋势指导临床管理。Objective To study the change in regional oxygen saturation(rSO_(2))of intestinal tissue in preterm infants with hemodynamically significant patent ductus arteriosus(hsPDA)by near-infrared spectroscopy,and the clinical significance of the change in intestinal oxygen level in preterm infants with hsPDA.Methods The preterm infants with patent ductus arteriosus(PDA)who had gestational age<32 weeks and/or birth weight<1500 g were prospectively enrolled,who were admitted to the Department of Neonatology,Shenzhen Longgang Central Hospital from October 2017 to October 2020.According to the diagnostic criteria for hsPDA,the preterm infants with patent ductus arteriosus(PDA)were divided into two groups:hsPDA and non-hsPDA.According to closure of the ductus arteriosus after oral administration of ibuprofen,the preterm infants in the hsPDA group were subdivided into two groups:hsPDA closure and hsPDA non-closure.Hemodynamic parameters were measured at diagnosis of PDA and after treatment,and the level of intestinal tissue rSO_(2) was monitored continuously to analyze its change.Results A total of 241 preterm infants with PDA were enrolled,with 55 infants(22.8%)in the hsPDA group and 186 infants(77.2%)in the non-hsPDA group.There were 36 infants(65%)in the hsPDA closure group and 19 infants(35%)in the hsPDA non-closure group.Compared with the non-hsPDA group,the hsPDA group had a significantly higher left atrial diameter/aortic root diameter ratio and significantly lower left ventricular ejection fraction and fractional shortening(P<0.05).At each time point within 6 hours after diagnosis (1, 2, 4, and 6 hours), the hsPDA group had significantly lower intestinal tissue rSO_(2) than the non-hsPDA group (P<0.05), and intestinal tissue rSO_(2) gradually decreased over time in the hsPDA group (P<0.05), with the lowest level of 0.448±0.014 at 6 hours. Compared with the hsPDA non-closure group, the hsPDA closure group had a significantly lower left atrial diameter/aortic root diameter ratio and significantly higher left ventricula

关 键 词：动脉导管未闭 近红外光谱技术 局部组织氧饱和度 氧合 早产儿 

分 类 号：R722.6[医药卫生—儿科]