PDF(Pubmed)
Abstract：
Early extubation is considered to be beneficial for pre-term neonates. On the other hand, premature extubation can cause lung derecruitment, compromised gas exchange, and need for reintubation, which may be associated with severe brain injury caused by sudden cerebral blood flow changes. We used near infrared spectroscopy (NIRS) to investigate changes in cerebral oxygenation (rScO2) and fractional tissue oxygen extraction (+) after extubation in pre-term infants. This is a single-center retrospective study of NIRS data at extubation time of all consecutive pre-term neonates born at our institution over a 1-year period. Comparison between subgroups was performed. Nineteen patients were included; average gestational age (GA) was 29.4 weeks. No significant change was noted in rScO2 and cFTOE after extubation in the whole population. GA and germinal matrix hemorrhage (GMH)-intraventricular hemorrhage (IVH) showed a significant change in rScO2 and cFTOE after extubation. A significant increase in cFTOE was noted in patients with previous GMH-IVH (+0.040; p = 0.05). To conclude, extubation per se was not associated with significant change in cerebral oxygenation and perfusion. Patients with a diagnosed GMH-IVH showed an increase in cFTOE, suggesting perturbation in cerebral perfusion suggesting further understanding during this challenging phenomenon. Larger studies are required to corroborate our findings.
摘要：
早期拔管被认为对早产儿有益。另一方面,过早拔管会导致肺部扩张,受损的气体交换，需要重新插管，这可能与突然的脑血流变化引起的严重脑损伤有关。我们使用近红外光谱（NIRS）研究了早产儿拔管后脑氧合（rScO2）和部分组织氧提取（）的变化。这是一项单中心回顾性研究，研究了在我们机构1年内出生的所有连续早产新生儿在拔管时的NIRS数据。进行亚组之间的比较。包括19例患者；平均胎龄（GA）为29.4周。在整个人群中，拔管后rScO2和cFTOE均无明显变化。GA和生发基质出血（GMH）-脑室内出血（IVH）在拔管后显示rScO2和cFTOE的显着变化。在先前患有GMH-IVH的患者中，cFTOE显着增加（0.040；p=0.05）。最后，拔管本身与脑氧合和灌注的显著变化无关。诊断为GMH-IVH的患者显示CFTOE增加，提示脑灌注的扰动，提示在这种具有挑战性的现象中进一步理解。需要更大规模的研究来证实我们的发现。
