背景:内脏-脑氧合比(SCOR),内脏组织氧(StO2s)与同时测量的脑组织氧(StO2c)之比,已被描述为检测与低灌注状态相关的内脏氧合受损的替代方法,例如坏死性小肠结肠炎。此概念基于以下假设:SCOR的任何变化都表明内脏组织氧合的相应变化作为分子,而作为分母的脑组织氧合保持稳定。然而,在充血红细胞输注(PRBCT)的情况下,利用这一概念检测内脏氧合变化是有问题的.
目的:本研究检查了早产儿脑和内脏氧合成分对PRBCT相关SCOR变化的影响。
方法:前瞻性队列研究。
方法:新生儿重症监护。
方法:血流动力学稳定的婴儿:妊娠<32周;出生体重<1500g;月经后年龄<37周:耐受≥120ml/kg/天的饲料量。
方法:PRBCT为15ml/kg,超过4小时。
方法:通过在4小时平均输血前值(SCOR0,StO2s0和StO2c0)和下一个28小时的输血后小时平均值(SCOR1-28,StO2s1-28和StO2c1-28)之间进行重复测量分析,确定输血相关变化。使用Dunnett的方法来调整p值的多重性。
结果:在30名登记的婴儿中,14名男性[46.7%];中位[IQR]出生体重,923[655-1064]g;妊娠,26.4[25.5-28.1]周;注册体重,1549[1113-1882]g;和月经后年龄,33.6[32.4-35.0]周,1例婴儿因NIRS数据受损而被排除.随着PRBCT的开始,SCOR在整个研究期间呈现下降趋势。这种漂移与增加的StO2c趋势有关,而StO2在整个研究期间保持不变。
结论:与PRBCT相关的SCOR降低提示脑氧合改善,而不是内脏氧合恶化。我们的研究强调,有必要确定SCOR的各个组成部分,即大脑和内脏StO2了解SCOR在PRBCT背景下的变化。
BACKGROUND: Splanchnic-cerebral oxygenation ratio (SCOR), the ratio of splanchnic tissue oxygen (StO2 s) to simultaneously measured cerebral tissue oxygen (StO2 c), has been described as a surrogate to detect impaired splanchnic oxygenation associated with hypoperfusion status such as necrotizing enterocolitis. This concept is based on the presumption that any change in SCOR indicates a corresponding change in splanchnic tissue oxygenation as the numerator, whereas cerebral tissue oxygenation as the denominator remains stable. However, it is questionable to utilise this concept to detect splanchnic oxygenation changes in the context of packed red blood cell transfusion (PRBCT).
OBJECTIVE: The current study examines the contribution of both cerebral and splanchnic oxygenation components to PRBCT-associated SCOR changes in preterm infants.
METHODS: Prospective cohort study.
METHODS: Neonatal intensive care.
METHODS: Hemodynamically stable infants: Gestation <32 weeks; birth weight <1500 g; postmenstrual age <37 weeks: tolerating ≥120 ml/kg/day feed volume.
METHODS: PRBCT at 15 ml/kg, over 4 h.
METHODS: Transfusion-associated changes were determined by performing mixed models for repeated measures analysis between the 4-h mean pre-transfusion values (SCOR 0, StO2 s 0, and StO2 c 0) and the post-transfusion hourly mean values for the next 28 h (SCOR 1-28, StO2 s 1-28, and StO2 c 1-28). Dunnett\'s method was used to adjust for the multiplicity of the p value.
RESULTS: Of 30 enrolled infants 14 [46.7%] male; median [IQR] birth weight, 923 [655-1064] g; gestation, 26.4 [25.5-28.1] weeks; enrolment weight, 1549 [1113-1882] g; and postmenstrual age, 33.6 [32.4-35.0] weeks, one infant was excluded because of corrupted NIRS data. With the commencement of PRBCT, SCOR demonstrated a downward trend throughout the study period. This drift was associated with an increasing StO2 c trend, while StO2 s remained unchanged throughout the study period.
CONCLUSIONS: PRBCT-associated SCOR decrease suggests improvement in cerebral oxygenation rather than worsening splanchnic oxygenation. Our study underlines that it is necessary to determine individual components of SCOR, namely cerebral and splanchnic StO2 to understand SCOR changes in the context of PRBCT.