胎粪吸入综合征新生儿脑组织氧饱和度的研究

Regional cerebral oxygen saturation in neonates with meconium aspiration syndrome

目的探讨胎粪吸入综合征（MAS）不同时相对新生儿局部脑组织氧饱和度（regional oxygen saturation，rSO2）的影响因素及合并缺氧缺血性脑病时脑组织氧饱和度变化的意义。方法根据MAS的临床表现分为无症状型、普通型、重型。应用TSNIR-3无创组织氧监测仪，测定其出生后1，3，5，7d时的脑组织氧饱和度变化，并与正常足月新生儿进行比较。结果MAS无症状型与正常对照组的rSO2在出生后第1天（58．37±4．12VS60．43±2．85）、第3天（57．76±2．33VS60．17±3．46）比较差异有显著性（P〈0．05）；MAS普通型、重型生后的第1，3，5天时脑组织rSO2明显降低，MAS重型、普通型与无症状型、正常对照组的rSO2在出生后第1，3，5天比较差异有显著性（P〈0．05）。MAS合并轻度HIE组与中-重度HIE组比较，rSO2在发病的第1天差异无显著性意义（P〉0．05），第2，3，5天比较（57．60±3．60VS53．36±4．48；55．60±2．35VS51．36±3．20；56．80士2．78vs53．22±5．10）差异均有显著性意义（P〈0．05）。结论MAS患儿在生后的不同时相脑组织rSO2受到不同程度的影响，缺氧的加重和持续时间增加可使脑氧合功能进一步损害。

Objective This study examined the changes of regional cerebral oxygen saturation （rSO2 ） by noninvasive near infrared spectrophotometry in neonates with meeonium aspiration syndrome （MAS）. Methods Seventy-three full neonates with MAS were divided into three groups by respiratory symptoms ： asymptomatic group （ group 1, n = 38 ）, common group （ group 2, n = 28 ） and severe group （ group 3, n = 7 ）. Near infrared spectrophotometry was used to measure the cerebral rSO2 on days 1,3, 5 and 7 after birth. Thirty healthy full-term newborns served as the Control group. Results The cerebral rSO2 of group 1 decreased significantly compared with that of the Control group between days 1 and 3 （ P 〈 0.05 ）. The cerebral rSO2 of group 2 or group 3 was significantly lower than that of group 1 and the Control group on days 1, 3 and 5 （ P 〈 0.05 ）. The MAS patients with mild hypoxic-ischemic encephalopathy （HIE） had significantly higher brain rSO2 levels than those with medium or severe HIE on days 2, 3 and 5 （ P 〈 0.05 ）. Conclusions The cerebral rSO2 decreased in neonates with MAS. The values for rSO2 correlate with the severity of HIE in MAS patients.