CAJ | 학술논문

目的探讨近红外光谱技术产时监测宫内缺氧性脑损伤的价值,为临床评价脑损伤提供客观、量化依据.方法 63例宫内窘迫胎儿根据出生后是否合并新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)分为HIE组(34例)及无HIE组(29例);35例无宫内窘迫的正常新生儿为对照组.应用近红外光谱技术测定3组新生儿胎头拨露时和生后5 min时脑组织氧饱和度(regional oxygen saturation,rSO2),受试者工作特性曲线评价脑rSO2对HIE的诊断价值.结果 HIE组患儿产程中胎头拨露及生后5 min时脑rSO2分别为(36.6±5.0)%和(52.0±4.2)%,均明显低于对照组[分别为(45.9±4.6)%和(59.6±4.4)%]及宫内窘迫但无HIE组[分别为(44.1±3.1)%和(57.6±3.5)%](P<0.01).对照组、宫内窘迫但无HIE组、HIE组产程中胎头拨露时脑rSO2与脐动脉血气pH值间均呈正相关性(r=0.463,P<0.01;r=0.619,P<0.01;r=0.688,P<0.01),与脐动脉血气血氧饱和度间亦呈正相关性(r=0.709,P<0.01;r=0.736,P<0.01;r=0.516,P<0.01).以胎头拨露时脑rSO2<39.5%为界值,rSO2评判宫内窘迫新生儿发生HIE的敏感性及特异性分别为67%及93%;以生后5 min脑rSO2<53.5%为界值,rSO2评判宫内窘迫新生儿发生HIE的敏感性及特异性分别为70%及86%.结论近红外光谱技术测定脑rSO2能客观评价宫内窘迫新生儿脑氧合状态,可提示新生儿HIE的存在.
목적 탐토근홍외광보기술산시감측궁내결양성뇌손상적개치,위림상평개뇌손상제공객관、양화의거.방법 63례궁내군박태인근거출생후시부합병신생인결양결혈성뇌병(hypoxic-ischemic encephalopathy,HIE)분위HIE조(34례)급무HIE조(29례);35례무궁내군박적정상신생인위대조조.응용근홍외광보기술측정3조신생인태두발로시화생후5 min시뇌조직양포화도(regional oxygen saturation,rSO2),수시자공작특성곡선평개뇌rSO2대HIE적진단개치.결과 HIE조환인산정중태두발로급생후5 min시뇌rSO2분별위(36.6±5.0)%화(52.0±4.2)%,균명현저우대조조[분별위(45.9±4.6)%화(59.6±4.4)%]급궁내군박단무HIE조[분별위(44.1±3.1)%화(57.6±3.5)%](P<0.01).대조조、궁내군박단무HIE조、HIE조산정중태두발로시뇌rSO2여제동맥혈기pH치간균정정상관성(r=0.463,P<0.01;r=0.619,P<0.01;r=0.688,P<0.01),여제동맥혈기혈양포화도간역정정상관성(r=0.709,P<0.01;r=0.736,P<0.01;r=0.516,P<0.01).이태두발로시뇌rSO2<39.5%위계치,rSO2평판궁내군박신생인발생HIE적민감성급특이성분별위67%급93%;이생후5 min뇌rSO2<53.5%위계치,rSO2평판궁내군박신생인발생HIE적민감성급특이성분별위70%급86%.결론 근홍외광보기술측정뇌rSO2능객관평개궁내군박신생인뇌양합상태,가제시신생인HIE적존재.
Objective To discuss the significance of near infrared spectroscopy (NIRS) in evaluation of intrapartum hypoxic-ischemic cerebral injury, and to provide a method to evaluate neonatal brain damage objectively and quantitatively. Methods A total of 63 neonates with fetal distress were divided into hypoxic-ischemic encephalopathy(HIE) group and non-HIE group. Thirtyfive newborns with no fetal distress were chosen as controls. Using NIRS, the brain regional oxygen saturation(rSO2) in these neonates were measured. Evaluation of brain rSO2 in the diagnosis of HIE was analyzed with receiver operating characteristic (ROC) curve. Results At the time of fetal head visible on vulval gapping and 5 min after birth, the HIE group showed decreased brain rSO2[(36. 6±5.0)% and (52. 0±4. 2)%], comparing with control group[(45. 9±4. 6)% and (59. 6±4. 4)%]and non-HIE group[(44.1±3.1) % and (57. 6±3. 5) %](P<0. 01) . The brain rSO2 was positively correlated with the pH and oxygen saturation of umbilical artery blood in all groups (P<0. 01). When the cut-off value of brain rSO2 was <39. 5% at fetal head visible on vulval gapping, the sensitivity and specificity of assessing HIE were 67% and 93%, respectively, while 70% and 86% when the cut-off value was <53. 5% at 5 min after birth. Conclusions The brain rSO2 obtained by NIRS could be used to evaluate brain oxygenation, and may be useful in predicting HIE in neonates with fetal distress.