胎粪吸入综合征患儿脑组织氧饱和度的监测及护理

Monitoring and Nursing rSO2 of Cerebral Tissue of Baby Patients with Meconium Aspiration Syndrome

目的探讨胎粪吸入综合征(MAS)患儿脑组织氧饱和度监测情况及相应的护理方法。方法将73例MAS患儿按病情分为两组,轻型38例为MASⅠ组,中、重型35例为MASⅡ组,应用无创组织氧监测仪对生后1、3、5、7 d的MAS患儿进行脑组织氧合状态的监测,并与正常新生儿进行比较。结果生后的1、3、5、7 d,正常新生儿与MASⅠ组和MASⅡ组患儿脑组织氧饱和度比较,MAS患儿的脑组织氧饱和度均有不同程度的降低。MASⅠ组患儿临床虽无明显缺氧症状及体征、肺部病变较轻,但与正常新生儿比较,出生后第3天的脑组织氧饱和度(rSO2)有显著性差异(P<0.01);MASⅡ组患儿生后的第1、第3、第5、第7天脑组织rSO2明显降低,与正常新生儿比较,各时相rSO2均有显著性差异(P<0.01)。结论MAS患儿脑组织rSO2受到不同程度的影响,缺氧的加重和持续时间增加可进一步加剧脑损伤,对MAS患儿应积极行呼吸道管理及加强护理,避免缺氧加重。采用近红外光谱测定技术对MAS的患儿进行动态监测,早期了解脑组织氧合状态,结合全身氧供需的变化,及时调整氧疗措施,对减轻缺氧脑损伤发生有重要的临床指导意义。

Objective To explore monitoring rSO2 of cerebral tissue of baby with meconium aspiration syndrome （MAS） and nursing methods. Methods Seventy-three baby patients with MAS were divided into two groups according to the degree of disease. Patients with light disease were group MASⅠ and those with serious disease were group MASⅡ. Noninvasive Tissue Oximeter was used to monitor the rSO2 of cerebral tissue of baby patients who were born 1, 3, 5, 7d ago and they were compared with normal babies. Results Compared with normal babies who were born 1, 3, 5, 7 d ago, baby patients in group MASⅠ and MASⅡ had lower rSO2. Baby patients in group MASⅠ who were born 3d ago had no obvious anoxia clinically and light pulmonary disease, but there was significant difference in rSO2 between them and normal babies （P〈0.01）; Compared with normal babies, those in group MASⅡ who were born 1, 3, 5 7 d ago had obviously low rSO2 （P〈0.01）. Conclusion rSO2 of baby with MAS is lower to some degree and anoxia with serious degree and long time can injury brain. In order to avoid aggravating the disease, it is necessary to manage respiratory tract actively and enhance nursing. Monitoring rSO2 by adopting NIRS, understanding the rSO2 in early stage and adjusting oxygenic therapy timely will have an important clinical meaning.