窒息新生儿49例脑组织氧饱和度研究

Study of cerebral tissue oxygenation among 49 cases of asphyxiated newborns

目的：探讨窒息新生儿脑组织氧饱和度的变化，指导对窒息新生儿的处理。方法：选取足月窒息新生儿49例和足月正常新生儿29例，应用红外组织血氧参数无损监测仪TSAH-100型测量新生儿出生后2—8h，第2、3、5、7、10天脑组织氧饱和度。根据出生12h的血气分析，新生儿分为窒息伴代谢性酸中毒组、窒息无代谢性酸中毒组及对照组。结果：窒息无代谢性酸中毒组和窒息伴代谢性酸中毒组的新生儿脑组织氧饱和度在出生后2—8h与对照组比较无显著性差异。窒息无代谢性酸中毒组的新生儿在出生后第2、3天脑组织氧饱和度与对照组比较有显著性差异；第5、7、10天脑组织氧饱和度与对照组比较无显著性差异。窒息伴代谢性酸中毒组的新生儿脑组织氧饱和度在出生后第2、3、5、7、10天与对照组比较均有显著性差异。顺产组与剖宫产组窒息新生儿脑组织氧饱和度比较无显著性差异。结论：窒息新生儿存在窒息缺氧后早期脑血流高灌注。窒息无代谢性酸中毒的新生儿缺氧程度轻，恢复快。窒息伴代谢性酸中毒对新生儿脑组织rSO2的影响可在第10天仍未恢复，提示这些新生儿有缺氧缺血性脑损伤。窒息新生儿的分娩方式与新生儿脑组织氧饱和度无直接关系。

Objective： To explore the changes of cerebral tissue oxygenation in asphyxiated newborns, and to direct the treatment of asphyxiated newborns. Methods： Using TSAH - 100 （Tsinghua near - infrared spectroscopy） non - invasive monitoring of tissue oxygenation, the cerebral regional oxygen saturation （rSo） was measured in 49 asphyxiated and 29 normal term infants, respectively at 2 -8 hourand the second, third, fifth, seventh and the tenth day after birth. According to the blood gas of 12 h after birth, infants were divided to asphyxiated group with metabolic acidosis, asphyxiated group with no metabolic acidosis and control group. Results： No significant differences were detectable at 2 - 8 h after birth between the two asphyxiated group and control group. The rSo2 of asphyxiated group with no metabolic acidosis on the second and third day after birth were significantly different with that of control group. But no significant differences were observed between the two groups on the fifth, seventh and tenth day after birth. Significant differences were observed between asphyxiated group with metabolic acidosis and control group on the second, third, fifth, seventh and tenth day after birth. No significant differences were observed between cesarean delivery asphyxiated newborns and vaginal ones. Conclusion. Early stage cerebra has higher perfusion after hypoxia exist in asphyxiated newborns. The degree of hypoxia in asphyxiated group with no metabolic acidosis is milder and the recovery is faster as well. The rSo2 of asphyxiated group with metabolic acidosis do not recover even on the tenth day after birth, which includes that those newborns have got hypoxic - ischemic cerebral injury. And there is no directly relationship between the delivery mode of the asphyxiated newborns and the rSo2 of newborns.