中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2009年
7期
517-522
,共6页
周丛乐%刘云峰%张家洁%谢立娟%李志光%王丹华%张巍%周晓光%王俊怡%刘颖%李岳
週叢樂%劉雲峰%張傢潔%謝立娟%李誌光%王丹華%張巍%週曉光%王俊怡%劉穎%李嶽
주총악%류운봉%장가길%사립연%리지광%왕단화%장외%주효광%왕준이%류영%리악
谱学,近红外线%婴儿,新生%缺氧,脑%血氧测定法%多中心研究
譜學,近紅外線%嬰兒,新生%缺氧,腦%血氧測定法%多中心研究
보학,근홍외선%영인,신생%결양,뇌%혈양측정법%다중심연구
Spectroscopy,near-infrared%Infant,newborn%Hypoxia,brain%Oximetry%Muiticenter studies
目的 探讨近红外光谱测定技术(near-infrared spectroscopy,NIRS)检测新生儿局部脑组织氧饱和度(Regional oxygen saturation,rSO2)对评估脑氧合状态的价值,建立新生儿脑rSO2的测定值,为临床应用提供依据.方法 采用NIRS技术对无特殊疾病的223例足月儿和95例早产儿分别在生后第1天、第2天及第3天进行脑rSO2测定,选取102例患有影响脑氧合疾病的新生儿,对照两组间脑rSO2数值差异.同步分析脑rSO2与脉搏氧饱和度(pulse oxygen saturation,SpO2)及动脉血氧饱和度(arterial oxygen saturation,SaO2)间的关系.结果 (1)正常足月新生儿脑rSO2测定值为(62±2)%,以低于两个标准差作为脑rSO2测定值异常,可以认为低于58%提示为脑组织缺氧.疾病状态新生儿脑rSO2范围(55±7)%,与无特殊疾病新生儿组差异有统计学意义(P<0.05).(2)脑rSO2与经皮SpO2及SaO2呈正相关,直线相关系数r分别为0.74和0.71.(3)特殊的疾病状态下,脑rSO2与SpO2可出现不同步的变化趋势,表现为:①spO2尚正常,而脑rSO2已降低.体现在18例严重的颅脑疾病及血红蛋白较低的病例.②一些危重病儿病情恢复过程中,脑rSO2的恢复滞后于SpO2在6例多脏器功能衰竭患儿尤为突出.③在3例重度缺氧缺血性脑损伤(HIE)急性期,脑rSO2有异常增高现象.结论 正常足月新生儿脑rSO2测定值为(62±2)%,低于58%提示脑组织缺氧.NIRS技术客观反映了脑组织的氧合变化,可为临床应用提供依据.
目的 探討近紅外光譜測定技術(near-infrared spectroscopy,NIRS)檢測新生兒跼部腦組織氧飽和度(Regional oxygen saturation,rSO2)對評估腦氧閤狀態的價值,建立新生兒腦rSO2的測定值,為臨床應用提供依據.方法 採用NIRS技術對無特殊疾病的223例足月兒和95例早產兒分彆在生後第1天、第2天及第3天進行腦rSO2測定,選取102例患有影響腦氧閤疾病的新生兒,對照兩組間腦rSO2數值差異.同步分析腦rSO2與脈搏氧飽和度(pulse oxygen saturation,SpO2)及動脈血氧飽和度(arterial oxygen saturation,SaO2)間的關繫.結果 (1)正常足月新生兒腦rSO2測定值為(62±2)%,以低于兩箇標準差作為腦rSO2測定值異常,可以認為低于58%提示為腦組織缺氧.疾病狀態新生兒腦rSO2範圍(55±7)%,與無特殊疾病新生兒組差異有統計學意義(P<0.05).(2)腦rSO2與經皮SpO2及SaO2呈正相關,直線相關繫數r分彆為0.74和0.71.(3)特殊的疾病狀態下,腦rSO2與SpO2可齣現不同步的變化趨勢,錶現為:①spO2尚正常,而腦rSO2已降低.體現在18例嚴重的顱腦疾病及血紅蛋白較低的病例.②一些危重病兒病情恢複過程中,腦rSO2的恢複滯後于SpO2在6例多髒器功能衰竭患兒尤為突齣.③在3例重度缺氧缺血性腦損傷(HIE)急性期,腦rSO2有異常增高現象.結論 正常足月新生兒腦rSO2測定值為(62±2)%,低于58%提示腦組織缺氧.NIRS技術客觀反映瞭腦組織的氧閤變化,可為臨床應用提供依據.
목적 탐토근홍외광보측정기술(near-infrared spectroscopy,NIRS)검측신생인국부뇌조직양포화도(Regional oxygen saturation,rSO2)대평고뇌양합상태적개치,건립신생인뇌rSO2적측정치,위림상응용제공의거.방법 채용NIRS기술대무특수질병적223례족월인화95례조산인분별재생후제1천、제2천급제3천진행뇌rSO2측정,선취102례환유영향뇌양합질병적신생인,대조량조간뇌rSO2수치차이.동보분석뇌rSO2여맥박양포화도(pulse oxygen saturation,SpO2)급동맥혈양포화도(arterial oxygen saturation,SaO2)간적관계.결과 (1)정상족월신생인뇌rSO2측정치위(62±2)%,이저우량개표준차작위뇌rSO2측정치이상,가이인위저우58%제시위뇌조직결양.질병상태신생인뇌rSO2범위(55±7)%,여무특수질병신생인조차이유통계학의의(P<0.05).(2)뇌rSO2여경피SpO2급SaO2정정상관,직선상관계수r분별위0.74화0.71.(3)특수적질병상태하,뇌rSO2여SpO2가출현불동보적변화추세,표현위:①spO2상정상,이뇌rSO2이강저.체현재18례엄중적로뇌질병급혈홍단백교저적병례.②일사위중병인병정회복과정중,뇌rSO2적회복체후우SpO2재6례다장기공능쇠갈환인우위돌출.③재3례중도결양결혈성뇌손상(HIE)급성기,뇌rSO2유이상증고현상.결론 정상족월신생인뇌rSO2측정치위(62±2)%,저우58%제시뇌조직결양.NIRS기술객관반영료뇌조직적양합변화,가위림상응용제공의거.
Objectives To understand the value of measuring neonatal cerebral regional oxygen ‘saturation(rSO2)using near infrared spectroscopy (NIRS) in assessing cerebral oxygenation,to establish the normal range of neonatal cerebral rSO2,and to collect data of the changes of cerebral rSO2 under certain disease status.Methods Nine large hospitais participated in the multicenter randomized clinical trial from Jan 2007 to Apr 2008.Using the NIRS human tissue oximeter(TSAH-100)independently developed in China.tIle cerebral rSO2 of 223 normal full-term and 95 otherwise healthy preterm neonates without any stmcial disease,Was detected at 1.2 and 3 days after birth,respectively.The cerebral rSO2 of 102 neonates with diseases which may affect the cerebral oxygenation.Was also detected during the severe phases.The pulse oxygen saturation(SpO2)measured at the finger tip,and also the arterial oxygen saturation(SaO2) measured by blood gas analysis,which could indicate the oxygen supply of the whole body,were obtained simultaneously.The correlations among cerebral rSO2,putse SpO2 and arterial SaO2 were analyzed.Results (1)The cerebral rSO2 of the normal full-term neonates wag(62±2)%.Cerebral hypoxia Was deftned as rSO2 lower than 58%. The cerebral rSO2 of the normal full-terms was steady at 1, 2 and 3 days after birth respectively, without any significant differences among them (F = 0. 610, P >0. 05 ). The cerebral rSO2 of the neonates with diseases was ( 55 + 7 ) %, which was significantly lower that that of the normal full-term neonates (t = 15.492,P <0. 05). (2) The cerebral rSO2 was positively correlated with the SpO2(r =0. 74,P < 0. 01 ) and the SaO2 ( r = 0. 71, P < 0. 01 ). ( 3 ) Under some special diseases, the changes of cerebral relatively low hemoglobin concentration, the cerebral rSO2 was significantly low (50%～58% ), but the cerebral rSO2 was lagged as compared with that of pulse SpO2. Especially, during the severe phases of 6 cases with multi-organ failure, the SpO2 and the cerebral rSO2 were both significantly low (55%～80% for SpO2, and 44%～50% for cerebral rSO2 ) ; when the diseases were alleviated, although the SpO2 recovered phases of serious hypoxic-ischemic encephalopathy (HIE), the cerebral rSO2 significantly increased to 70%～72%, which was significantly higher than the normal value (62%). Condusions The range of cerebral rSO2 of the normal full-term neonates was (62 + 2) %. Cerebral oxygenation can be externally indicated by the rSO2 noninvasively and continuously measured by NIP, S, which was positively correlated with traditional pulse SpO2 and arterial SaO2. In some special diseases, the rSO2 measured by NIRS can be helpful for clinical diagnoses and treatments.
