近红外光谱仪指标与新生儿复杂先天性心脏病术后结局相关性的初步研究  

Study on Correlation Between Near-infrared Spectroscopy Derived Parameters and Postoperative Outcome of Neonates With Complex Congenital Heart Disease

作　　者：刘巧 窦豆 别东韵 安然 贾爰[1] 袁素[1] 王嵘[1] 晏馥霞[1] LIU Qiao;DOU Dou;BIE Dongyun;AN Ran;JIA Yuan;YUAN Su;WANG Rong;YAN Fuxia(Department of Anesthesiology,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院麻醉科,北京100037

出　　处：《中国循环杂志》2023年第11期1177-1182,共6页Chinese Circulation Journal

基　　金：国家自然科学基金(82000100)。

摘　　要：目的:分析行复杂先天性心脏病(先心病)手术的新生儿术中近红外光谱仪(near-infraredspectroscopy,NIRS)监测指标与术后结局的关系。方法:本研究为回顾性观察性研究,纳入2021年至2022年在中国医学科学院阜外医院行复杂先心病手术且术中进行NIRS监测的新生儿37例,分析患儿围术期相关资料及术中NIRS指标变化情况,探索NIRS指标与术后结局的关系。依据最大约登指数确定NIRS指标的最佳界值,并以此将患者分为两组,观察两组患者的术后结局。结果:37例患儿中早产儿占16.2%,体外循环时间为(137.6±8.4)min,基线脑氧饱和度为(64.4±1.4)%,基线肾氧饱和度为(68.6±1.3)%,术中脑氧饱和度下降程度(Δ脑氧饱和度)、肾氧饱和度下降程度(Δ肾氧饱和度)分别为15.1(7.3,24.3)%和7.9(4.5,18.6)%。共10例(27.0%)患儿发生了不良结局(包括院内死亡、术后连续性肾脏替代治疗、术后二次气管插管、再次开胸探查、再次剖腹探查、术后重症监护病房住院时间≥30 d)。相较于未发生不良结局的患儿,发生不良结局的患儿Δ肾氧饱和度明显升高[7.9(4.1,17.6)%vs.18.1(8.3,34.1)%,P<0.05]。14例(37.8%)患儿术后延迟拔管,相较于正常拔管患儿,延迟拔管患儿的Δ肾氧饱和度明显升高[7.9(4.1,18.3)%vs.13.9(7.4,21.9)%,标准均值差(SMD)>0.1]。依据最大约登指数,Δ肾氧饱和度9%为最佳界值,据此患者分为Δ肾氧饱和度>9%组(n=16)和Δ肾氧饱和度≤9%组(n=21)。与Δ肾氧饱和度≤9%组相比,Δ肾氧饱和度>9%组的术后不良结局发生率(19.0%vs.50.0%,SMD>0.1)和延迟拔管发生率(28.6%vs.50.0%,SMD>0.1)均较高,且术后重症监护病房住院时间较长,住院费用较高(SMD均>0.1)。结论:Δ肾氧饱和度可能与行复杂先心病手术的新生儿术后结局相关,Δ肾氧饱和度可辅助医师早期识别高危患者。Objectives:To analyze the association between near-infrared spectroscopy(NIRS)derived parameters and outcome of neonates post complex congenital heart surgery.Methods:This retrospective observational study included 37 neonates who underwent NIRS monitoring during complex congenital heart surgery from 2021 to 2022 in Fuwai Hospital.We analyzed the relationship between perioperative and intraoperative NIRS data with postoperative outcomes in these patients.The optimal threshold was determined by the maximum Youden index and patients were divided into two groups based on the optimal threshold,postoperative outcomes of two groups were compared.Results:This study included 37 patients,16.2%were premature infants,the average cardiopulmonary bypass time were(137.6±8.4)min.The baseline cerebral oxygen saturation and renal oxygen saturation were(64.4±1.4)%and(68.6±1.3)%,respectively.The reduction of intraoperative cerebraloxygen saturation(Δcerebraloxygen saturation)and the reduction of intraoperative of renal oxygen saturation(Δrenal oxygen saturation)were 15.1(7.3,24.3)%and 7.9(4.5,18.6)%,respectively.Ten patients(27.0%)were grouped in the adverse outcome group.Compared to the non-adverse outcome group,theΔrenal oxygen saturation of neonates in the adverse outcome group were significantly higher(7.9[4.1,17.6]%vs.18.1[8.3,34.1]%).Fourteen patients(37.8%)were grouped in the prolonged mechanical ventilation group,and theΔrenal oxygen saturation were significantly higher in this group compared to the non-prolonged mechanical ventilation group(13.9[7.4,21.9]%vs.7.9[4.1,18.3]%).The optimal cutoff Youden index ofΔrenal oxygen saturation was 9%.Patients were divided into two groups based on it,compared withΔrenal oxygen saturation≤9%(n=21),patients withΔrenal oxygen saturation>9%(n=16)had a higher incidence of postoperative adverse outcomes(19.0%vs.50.0%,SMD>0.1)and prolonged mechanical ventilation(28.6%vs.50.0%,SMD>0.1),a higher postoperative intensive care unit(ICU)stay time and hospitalization costs.Conclusions:Δ

关 键 词：近红外光谱仪 新生儿 先天性心脏病 心脏手术 肾氧饱和度 

分 类 号：R54[医药卫生—心血管疾病]