新生儿肾氧饱和度监测临床应用进展

Progress in clinical application of neonatal renal oxygen saturation monitoring

新生儿重症监护病房(NICU)中急性肾损伤(AKI)的发病率约为30%,胎龄越小、出生体质量越低、机械通气时间越长,AKI的发病率和死亡率越高。目前诊断AKI的主要指标是血清肌酐(Scr)和尿量,通常在不可逆损伤发生的12~48 h发生变化,不能用于早期诊断和临床干预。因此,需要寻找肾脏早期灌注不足的指标,能够早期进行干预,预防和减轻肾损伤的发生。近红外光谱技术(NIRS)作为一种无创、连续、实时的监测手段,可作为传统生化标志物的补充,提供肾脏早期缺氧缺血的证据,有助于预防或降低AKI。现拟对新生儿肾氧饱和度监测的临床应用进行综述,为危重新生儿肾功能保护提供临床参考,以减少临床AKI的发生,改善患儿预后。

The incidence of acute kidney injury(AKI)in Neonatal Intensive Care Unit(NICU)is about 30%.The morbidity and mortality of AKI are higher in very premature infants,very low birth weight infants and infants with long mechanical ventilation.Serum creatinine(Scr)and urine output are diagnostic indicators for AKI,which usually change within 12-48 hours after the onset of irreversible injury,and cannot be used for early diagnosis and clinical intervention.Therefore,it is necessary to search for indicators of early renal insufficiency,aiming to intervene and prevent early-stage AKI or reduce the occurrence of AKI.Near-infrared spectroscopy(NIRS)is a non-invasive,continuous,real-time monitoring method,which serves as a supplement to conventional biochemical markers.It provides evidence of early-stage renal ischemia and hypoxia,which contributes to prevent or reduce AKI.This study reviews the clinical application of neonatal renal oxygen saturation monitoring,thus providing clinical reference for renal function protection in critically ill neonates to reduce the occurrence of AKI and improve their prognosis.