极早产儿贫血及输血治疗对组织氧饱和度及血压的影响

Effect of anemia and blood transfusion on tissue oxygen saturation and blood pressure in extremely preterm infants

摘要:

贫血是极早产儿面临的常见问题之一，输血是最主要、最有效的治疗手段。然而，目前尚缺乏最佳的极早产儿输血指征。通过对脑及肠道组织氧饱和度和血压的监测，探讨贫血及输血对极早产儿组织氧供应及血压的影响，为极早产儿贫血合理输血治疗提供临床依据。方法选取28～31+6周极早产儿55 例，分为4 组：正常对照组、轻度贫血组、中度贫血组和重度贫血组。用近红外脑氧饱和度监测仪和多功能心电监护仪监测脑和肠道的氧饱和度和患儿的血压。结果输血前贫血组与对照组比较，脑及肠道氧饱和度均下降，差异有统计学意义（ p<0.05）；不同贫血组之间比较，脑组织氧饱和度在中度与重度组间差异无统计学意义（p >0.05）；而轻度与中、重度组比较差异均有统计学意义（p <0.05）；肠道组织氧饱和度在轻度与中度组间差异无统计学意义（p >0.05）；而轻、中度与重度组比较差异有统计学意义（p <0.05）；各组间血压（包括收缩压、舒张压和平均动脉压）差异无统计学意义（p >0.05）；输血过程中，中度及重度组脑及肠道氧饱和度逐渐增高，两组比较差异有统计学意义（p <0.05）；输血后，脑氧饱和度中度组与重度组比较差异有统计学意义（p <0.05）；而肠道氧饱和度两组差异无统计学意义（p >0.05）；输血过程中及输血后血压与输血前比较差异无统计学意义（p > 0.05）。在输血过程中肠道氧饱和度比脑氧饱和度波动大，恢复快。输血后两者达到一个高值后趋于稳定。结论不同程度的贫血均可导致极早产儿脑组织及肠道组织供氧减少，随着贫血程度加重组织供氧明显减少，输血可以很快缓解组织缺氧的情况，且对血压无明显影响。值得注意的是在输血过程中肠道组织氧饱和度波动较大。

Abstract:

To investigate the effect of anemia and transfusion on tissue oxygen supply and blood pressure in extremely preterm infants, so as to provide a clinical basis for reasonable blood transfusion in the anemic preterm infants. Methods Fifty-five cases of premature infants within 28-31+6 gestational weeks were divided into 4 groups including normal control group, mild anemia group, moderate anemia group and severe anemia group. Using far infrared cerebral oxygen saturation monitor and multifunctional ECG monitor, brain and intestinal oxygen saturation and blood pressure of the infants were monitored. Results Compared to the control group, the brain and intestinal oxygen saturation significantly decreased in the anemia groups before transfusion (p < 0.05). The brain tissue oxygen saturation was not significantly different between the moderate and severe anemia groups (p > 0.05), but the brain tissue oxygen saturation of the mild anemia group was significantly different from that of the moderate and severe groups ( p< 0.05). There was no significant difference in the intestinal tissue oxygen saturation betweenthe mild and moderate groups (p > 0.05), while the intestinal tissue oxygen saturation of the mild and moderate anemia groups was significantly different from that of the severe anemia group (p < 0.05). No significant changes in blood pressure (including systolic blood pressure, diastolic blood pressure and mean arterial pressure) were observed among the groups (p > 0.05). During the process of blood transfusion, the brain and intestinal oxygen saturation of the moderate and severe groups increased gradually, and there was significant difference between the two groups (p < 0.05). After blood transfusion, there was significant difference in the brain oxygen saturation between the moderate anemia group and the severe anemia group (p < 0.05), while there was no significant difference in the intestinal oxygen saturation between the two groups (p > 0.05). There was no significant difference in the blood pressure before and after blood transfusion (p > 0.05). In the course of blood transfusion, the fluctuation of the intestinal oxygen saturation was larger than that of cerebral oxygen saturation; each reached a high value and tended to be stable after blood transfusion. Conclusions Different degrees of anemia can lead to decreased oxygen supply in the brain and intestinal tissues of extremely premature infants. With the increasing of anemia degree, tissue oxygen supply obviously reduces. Blood transfusion can quickly alleviate tissue hypoxia and has no obvious effect on blood pressure. It is worth noting that in the course of blood transfusion intestinal tissue oxygen supply is unstable.