近红外光谱技术监测硫酸镁对重症手足口病合并心肺衰竭患儿脑氧合水平的影响  

Effect of intravenous magnesium sulfate as monitored by NIRS on cerebral oxygenation in children with cardiopulmonary failure secondary to severe hand-foot-mouth disease

作　　者：李鹏 宋春兰 成怡冰 崔亚杰 朱琳 李利平 Li Peng;Song Chunlan;Cheng Yibing;Cui Yajie;Zhu Lin;Li Liping(Henan Provincial Children's Hospital,Zhengzhou Children's Hospital,Children's Hospital Affiliated to Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]河南省儿童医院,郑州儿童医院,郑州大学附属儿童医院,郑州450003

出　　处：《中华生物医学工程杂志》2022年第3期288-293,共6页Chinese Journal of Biomedical Engineering

基　　金：河南省医学科技攻关计划(201602343, 201702326, LHGJ20190920)。

摘　　要：目的使用近红外光谱技术(NIRS)监测脑血氧代谢,探讨硫酸镁对重症手足口病(HFMD)合并心肺衰竭患儿脑氧合水平的影响。方法选取2015年3月至2018年3月郑州大学附属儿童医院收治的重症HFMD合并心肺衰竭患儿46例为研究对象,随机分为观察组和对照组,每组23例。对照组采用对症支持治疗,观察组在对症支持治疗的基础上予硫酸镁静脉滴注,连续治疗5 d。监测治疗后不同时点两组局部脑氧饱和度(rScO_(2))、血乳酸、上腔静脉血氧饱和度(ScvO_(2))水平,记录两组治疗前后振幅整合脑电图(aEEG)改变。结果治疗前对照组aEEG异常19例,观察组aEEG异常20例,aEEG异常率组间比较差异无统计学意义(P>0.05)。治疗后对照组aEEG恢复正常8例(42.1%),观察组aEEG恢复正常15例(75.0%),观察组aEEG恢复正常率显著高于对照组(χ^(2)=4.36,P=0.037)。入院后72 h、96 h对照组rScO2显著低于观察组(t=-2.90、-2.94,均P<0.05),入院后24 h、48 h、72 h观察组血乳酸较对照组显著下降(t=2.43、5.29、3.02,均P<0.05),入院后48 h、72 h、96 h观察组ScvO2较对照组显著升高(t=-5.23、-4.92、-5.13,均P<0.05)。观察组与对照组住院时间分别为(12.78±2.09)d、(14.04±2.12)d,观察组较对照组显著缩短(P<0.05)。临床疗效比较显示,观察组治疗总有效率显著高于对照组(95.7%比87.0%,χ^(2)=6.54,P=0.038)。结论重症HFMD患儿早期应用硫酸镁可尽快改善脑组织缺氧状况,保护脑功能。NIRS有助于辅助判断病情变化。Objective To investigate the effect of intravenous magnesium sulfate(MgSO_(4))on cerebral blood oxygen metabolism as monitored by near infrared spectroscopy(NIRS)in children with cardiopulmonary failure secondary to severe hand,foot and mouth disease(HFMD).Methods Included were 46 children with severe HFMD and cardiopulmonary failure hospitalized in the Children’s Hospital Affiliated to Zhengzhou University between March 2015 and March 2018.The children were randomly divided into the study group and control group(n=23 each).The control group was given symptomatic and supportive treatment,and the study group was treated with intravenous drip of magnesium sulfate in addition to the symptomatic and supportive treatment for five consecutive days.The levels of regional cerebral oxygen saturation(rScO_(2)),blood lactate,and superior vena cava oxygen saturation(ScvO_(2))were monitored at different time points after treatment.The amplitude integrated electroencephalogram(aEEG)before and after treatment were recorded.Results Before treatment,there were 19 children with abnormal aEEG in the control group vs 20 in the study group,with no significant difference in aEEG abnormality between the two groups(P>0.05).After treatment,8 children in the control group(42.1%)and 15 in the study group(75.0%)resumed normal aEEG,with significantly higher rate of normal aEEG resuming in the study group than that in the control group(χ^(2)=4.36,P=0.037).The rScO_(2) levels in the control group at 72 h and 96 h after admission were significantly lower compared with the study group(t=-2.90 and-2.94,both P<0.05).The blood lactic acid levels in the study group at 24 h,48 h,and 72 h after admission were significantly lower than those in the control group(t=2.43,5.29,and 3.02,all P<0.05).The ScvO_(2) levels in the study group were significantly higher than those in the control group at 48 h,72 h,96 h after admission(t=-5.23,-4.92,and-5.13,all P<0.05).The length of hospital stay in the study group was(12.78±2.09)days vs(14.04±2.12)days in the

关 键 词：手足口病 硫酸镁 近红外光谱技术 脑组织氧饱和度 

分 类 号：R725.1[医药卫生—儿科] R726.9[医药卫生—临床医学]