局部脑氧饱和度和肠道血氧饱和度对新生儿坏死性小肠结肠炎早期预警及手术治疗时机的指导价值

Regional cerebral oxygen saturation and regional intestinal oxygen saturation in early warning and surgical treatment of neonatal necrotizing enterocolitis

目的研究局部脑氧饱和度(rcSO_(2))和局部肠道血氧饱和度(rintSO_(2))与新生儿坏死性小肠结肠炎(NEC)病情程度的关系,探讨rcSO_(2)和rintSO_(2)对NEC早期预警及手术干预时机的指导意义。方法回顾性分析2021年3月至8月96例胎龄<32周早产儿临床资料,根据是否发生NEC分为三组:对照组49例,未发生NEC;疑似组14例,疑似发生NEC;NEC组33例,患有NEC。其中NEC组再根据是否手术分为两个亚组:手术组19例,非手术组14例。观察三组不同临床分期早产儿的rcSO_(2)和rintSO_(2)水平变化,Spearman相关性分析其与Bell分期的关系;利用受试者工作特征(ROC)曲线分析rcSO_(2)、rintSO_(2)预测NEC发生和手术时机的价值。结果(1)疑似组和NEC组rcSO_(2)及不同监测部位rintSO_(2)水平均较对照组明显降低,NEC组降低幅度较为显著(F=19.952~43.865,P<0.05)。rcSO_(2)及不同监测部位rintSO_(2)水平随Bell分期的升高而逐渐降低(F=5.298~12.866,P<0.05),并与Bell分期呈负相关(P<0.05)。当rcSO_(2)<74.3%,右侧腹rintSO_(2)<75.4%时,两者预测NEC的曲线下面积(AUC)分别为0.836、0.817,对应敏感度、特异度分别为78.8%、84.8%和81.8%、76.9%,诊断效能较高。(2)NEC手术组患儿rcSO_(2)及不同监测部位rint SO_(2)水平明显低于非手术组(t=2.341~4.815,P<0.05)。当rcSO_(2)<72.4%,右侧腹rintSO_(2)<71.5%时,两者预测NEC需行手术干预的AUC分别为0.755、0.729,对应敏感度、特异度分别为71.6%、79.4%和75.8%、66.7%,诊断效能较高。结论rcSO_(2)和rintSO_(2)水平变化与NEC患儿病情程度关系密切,应用近红外光谱技术监测两者水平变化对早期预警NEC发生及手术干预时机具有一定的指导价值。

Objective To study the performance of regional cerebral oxygen saturation(rc SO_(2))and regional intestinal oxygen saturation(rint SO_(2))in the neonates with different stages of necrotizing enterocolitis(NEC),and to explore the significance in the early warning of NEC and the timing of surgical intervention.Methods The clinical data of 96 premature infants with gestational age<32 weeks from March to August2021 were retrospectively analyzed.According to the occurrence of NEC,they were divided into three groups:49 infants without NEC in the control group;14 infants in the suspected group were suspected of NEC;33 infants in NEC group were diagnosed with NEC.Infants in the NEC group were divided into two subgroups according to whether surgery was performed,with 19 infants in the operation group and14 in the non-operation group.To observe the changes of rc SO_(2)and rint SO_(2)levels in the three groups of preterm infants with different clinical stages,Spearman correlation analysis of the relationship between them and Bell staging was carried out.Receiver operating characteristics(ROC)curve was used to analyze the value of rc SO_(2)and rint SO_(2)in predicting the occurrence of NEC and the timing of surgery.Results(1)rc SO_(2)levels in the suspected group and NEC group and rint SO_(2)levels in different monitoring sites were significantly lower than those in control group,and the decrease range was significantly higher in NEC group(F=19.952-43.865,P<0.05).Rc SO_(2)and rint SO_(2)levels in different monitoring sites decreased gradually with the increase of Bell staging(F=5.298-12.866,P<0.05),and were negatively correlated with Bell staging(P<0.05).When rc SO_(2)<74.3%and right abdominal rint SO_(2)<75.4%,the area under curvec(AUC)of NEC and rint SO_(2)were 0.836 and 0.817 respectively,and the corresponding sensitivity and specificity were78.8%,84.8%and 81.8%,76.9%,respectively,indicating high diagnostic efficiency.(2)Rc SO_(2)and rint SO_(2)levels in different monitoring sites in operation group were significantly lower than those in non-operation group(t=2.341-4.815,P<0.05).When rc SO_(2)<72.4%and right abdominal rint SO_(2)<71.5%,the AUC values for predicting surgical intervention of NEC were 0.755 and 0.729,respectively,and the corresponding sensitivity and specificity were 71.6%,79.4%and 75.8%,66.7%respectively,indicating high diagnostic efficiency.Conclusions The changes of rc SO_(2)and rint SO_(2)levels are closely related to the severity of NEC in neonates.The application of near-infrared spectroscopy technology to monitor rc SO_(2)and rint SO_(2)levels has certain guiding value for early warning NEC and guiding the timing of surgical intervention.