肺表面活性物质对早产儿脑氧代谢的影响

Effects of Pulmonary Surfactant on Cerebral Oxygen Metabolism in Preterm Infants

目的:应用近红外光谱法(NIRS)评估肺表面活性物质(PS)治疗对早产儿脑氧代谢的影响。方法:符合纳入标准的呼吸窘迫综合征(RDS)早产儿,生后2 h内持续正压通气(CPAP)治疗失败的予以插管-给药-拔管法(INSURE)联合PS治疗作为治疗组,单纯CPAP治疗的早产儿作为对照组。治疗开始前、治疗过程及治疗后的各5 min时长窗应用NIRS监测脑氧饱和度(ScO_(2)),同时监测血氧饱和度(SaO_(2)),计算脑摄氧率(FTOE)。结果:2018年3月至2019年2月广州市妇女儿童医疗中心出生的早产儿,符合标准纳入本研究的治疗组24例、对照组25例,两组患儿临床特征及应用PS治疗前的ScO_(2)和FTOE水平比较差异无统计学意义。治疗组给药期间,ScO_(2)水平较其基线水平升高(82.1%±6.4%vs 77.0%±3.7%,t=3.362,P=0.002),FTOE水平较基线水平降低(0.11±0.05 vs 0.19±0.05,t=5.552,P=0.000);给药后5 min ScO_(2)和FTOE均恢复至基线水平。给药期间,治疗组的ScO_(2)变化率(与基线水平的比率)高于对照组[1.049(1.026~1.122)vs 1.000(0.972~1.013),Z=135.0,P=0.001],而治疗组FTOE变化率较对照组大[0.560(0.378~0.794)vs 0.938(0.860~1.110),Z=99.00,P=0.000],相应时间段对照组ScO_(2)和FTOE与基线水平变化率比较差异无统计学意义(P>0.05)。结论:应用PS治疗RDS早产儿时可引起脑氧代谢发生明显变化,ScO_(2)升高,FTOE降低,为临床早产儿呼吸系统疾病的治疗提供更为合理的方式。

Object:To evaluate the effects of pulmonary surfactant(PS)therapy on cerebral oxygen metabolism in preterm infants through near infrared spectrum instrument(NIRS).Methods:Preterm infants with respiratory distress syndrome(RDS)that met the inclusion criteria were treated with intubation-surfactant-extubation(INSURE)combined with PS therapy if continuous positive airway pressure(CPAP)treatment failed within 2 h after birth.Preterm infants treated with CPAP alone were extracted as the control group.NIRS was used to monitor the cerebral oxygen saturation(ScO_(2))before treatment,during the treatment process and after treatment 5-min time window,the blood oxygen saturation(SaO_(2))was monitored,and the fractional tissue oxygen extraction(FTOE)was calculated.Results:Preterm infants born in Guangzhou Women and Children’s Medical Center from Mar.2018 to Feb.2019 who met the criteria were extracted,totally 24 cases in the treatment group and 25 cases in the control group.There were no statistically significant differences in clinical characteristics,ScO_(2) and FTOE levels before PS therapy between two groups.During administration of the treatment group,the ScO_(2)level was significantly higher than the baseline level(82.1%±6.4%vs 77.0%±3.7%,t=3.362,P=0.002),and the FTOE level was significantly lower than the baseline level(0.11±0.05 vs 0.19±0.05,t=5.552,P=0.000).ScO_(2) and FTOE levels returned to the baseline levels 5 min after administration.During administration,the rate of change in ScO_(2)(ratio to baseline level)in the treatment group was higher than that in the control group(1.049(from 1.026 to 1.122)vs 1.000(from 0.972 to 1.013),Z=135.0,P=0.001),while the rate of change in FTOE in the treatment group was greater than that in the control group(0.560(from 0.378 to 0.794)vs 0.938(from 0.860 to 1.110),Z=99.00,P=0.000),and there was no significant difference in the rate of change in ScO_(2) and FTOE in the control group and the baseline level in the corresponding duration(P>0.05).Conclusion:The application of PS in the treatment of preterm infants with RDS can cause significant changes in cerebral oxygen metabolism,an increase in ScO_(2) and a decrease in FTOE,providing a more rational approach to the treatment of respiratory diseases in clinical preterm infants.