红细胞输注对早产儿脑组织氧合的影响

Effect of red blood cell transfusion on cerebral tissue oxygenation in premature infants

目的分析红细胞输注前、中、后早产儿脑组织氧饱和度(CrSO2)和氧摄取分数(CFOE)的变化,探讨红细胞输注对早产儿脑组织氧合的影响。方法选取2017年9月至2018年3月复旦大学附属儿科医院新生儿科收治的出生胎龄<37周并输注红细胞治疗的早产儿,利用近红外光谱监测仪(NIRS)持续监测患儿红细胞输注前2 h、输注过程中至输注后24 h的脑组织CrSO2,利用多功能心电监护仪同步测量患儿经皮动脉氧饱和度(TcSaO2)、心率(HR)和血压(BP)。根据监测的TcSaO2计算患儿CFOE。结果共纳入患儿71例,其中男39例,女32例;中位出生胎龄29(24~37)周;中位出生体质量2 195(710~3 950) g;中度贫血组17例,重度贫血组54例。与红细胞输注前2 h比较,所有患儿红细胞输注过程中CrSO2升高(t=9.536,P<0.001),CFOE降低(t=-8.688,P<0.001)。中度贫血组输血前2 h,输血过程中,输血后2、6、12、24 h的CrSO2值分别为0.579±0.037、0.591±0.032、0.599±0.035、0.596±0.035、0.595±0.027、0.585±0.022;重度贫血组分别为0.571±0.038、0.592±0.039、0.605±0.038、0.603±0.035、0.596±0.032、0.596±0.032。中度贫血组输血前2 h,输血过程中,输血后2、6、12、24 h的CFOE值分别为0.40±0.04、0.38±0.03、0.37±0.04、0.38±0.04、0.38±0.03、0.38±0.03;重度贫血组分别为0.42±0.04、0.39±0.04、0.38±0.04、0.38±0.04、0.39±0.03、0.39±0.03。中度贫血组患儿红细胞输注过程后2 h的CrSO2升高(t=3.874,P<0.05),CFOE降低(t=-4.091,P<0.05);重度贫血组患儿红细胞输注过程中CrSO2明显升高(t=9.221,P<0.001),CFOE显著降低(t=-8.583,P<0.001),此作用一直持续至红细胞输注后2 h(t=5.926、-5.556,P<0.001)。与红细胞输注前2 h的CrSO2比较,重度贫血组患儿红细胞输注后24 h的CrSO2明显升高(t=6.894,P<0.001),而CFOE显著降低(t=-8.536,P<0.001);但中度贫血组患儿红细胞输注后24 h的CrSO2和FTOE与红细胞输注前2 h的差异无统计学意义。结论红细胞输注可改善早产儿脑组织氧合,重度贫血早产儿更受益于红细胞输注。NIRS监测仪脑氧合监测为早产儿红细胞输注的临床管理提供了新的思路。

Objective To analyze the changes in cerebral oxygen saturation (CrSO2) and cerebral fractional oxygen extraction ratio (CFOE) before, during and after red blood cell (RBC) transfusion in premature infants, and to explore the effect of RBC transfusion on the cerebral tissue oxygenation in premature infants. Methods The preterm infants with gestational age<37 weeks who were treated with RBC transfusion were selected from September 2017 to March 2018 in Neonatal Department of Children′s Hospital of Fudan University.Near-infrared spectroscopy (NIRS) was applied to continuously monitor CrSO2 from 2 h before RBC transfusion to 24 h after RBC transfusion.Transcuta-neous arterial oxygen saturation (TcSaO2), heart rate (HR) and blood pressure (BP) were synchronously measured by using multi-function monitor.CFOE could be calculated based on the monitored TcSaO2. Results A total of 71 cases were included in the study, 39 males and 32 females, with a medium gestational age of 29 (24-37) weeks, a mean birth weight of 2 195 (710-3 950) g, 17 cases in moderate anemia group and 54 cases in severe anemia group.Compared with the data 2 h before transfusion, CrSO2 increased (t=9.536, P<0.001), while CFOE decreased (t=-8.688, P<0.001) during transfusion in the whole study population.The CrSO2 at 2 h before blood transfusion, during blood transfusion, 2, 6, 12 and 24 h after transfusion were 0.579±0.037, 0.591±0.032, 0.599±0.035, 0.596±0.035, 0.595±0.027, 0.585±0.022, respectively in moderate anemia group and were 0.571±0.038, 0.592±0.039, 0.605±0.038, 0.603±0.035, 0.596±0.032, 0.596±0.032, respectively in severe anemia group.The CFOE at 2 h before blood transfusion, during blood transfusion, 2, 6, 12 and 24 h after transfusion were 0.40±0.04, 0.38±0.03, 0.37±0.04, 0.38±0.04, 0.38±0.03, 0.38±0.03, respectively in moderate anemia group and were 0.42±0.04, 0.39±0.04, 0.38±0.04, 0.38±0.04, 0.39±0.03, 0.39±0.03, respectively in severe anemia group.CrSO2 increased (t=3.874, P<0.05), while CFOE decreased (t=-4.091, P<0.05) at 2 h after transfusion in moderate anemia group.In severe anemia group, CrSO2 significantly increased (t=9.221, P<0.001), while CFOE significantly decreased (t=-8.583, P<0.001) during transfusion, and this effect lasted until 2 h after transfusion (t=5.926,-5.556, P<0.001). Compared with the data 2 h before transfusion, CrSO2 was significantly increased (t=6.894, P<0.001), while CFOE was significantly decreased (t=-8.536, P<0.001) at 24 h after transfusion in severe anemia group.However, there was no signi-ficant difference in CrSO2 and CFOE between the 24 h after transfusion and 2 h before in the moderate anemia group. Conclusions RBC transfusion improves cerebral tissue oxygenation, and severe anemia group benefit more from blood transfusion.Cerebral oxygenation monitoring with NIRS monitor may provide new insights for the clinical management of RBC transfusion in preterm infants.