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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 45 -49,68. doi: 10.3877/cma.j.issn.1674-0793.2023.01.009

论著

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
李小龙1, 彭飞1, 邢虹2, 张朋飞1, 徐泉1, 赵静儒1, 李占魁2, 郭金珍2, 白瑞苗2,†()   
  1. 1. 710061　西安，西北妇女儿童医院普通外科
    2. 710061　西安，西北妇女儿童医院新生儿科
  • 收稿日期:2022-06-21 出版日期:2023-02-01
  • 通信作者: 白瑞苗
  • 基金资助:
    陕西省重点研发计划项目(2021SF-195)

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

Xiaolong Li1, Fei Peng1, Hong Xing2, Pengfei Zhang1, Quan Xu1, Jingru Zhao1, Zhankui Li2, Jinzhen Guo2, Ruimiao Bai2,†()   

  1. 1. Department of General Surgery, Northwest Women and Children’s Hospital, Xi’an 710061, China
    2. Department of Neonatology, Northwest Women and Children’s Hospital, Xi’an 710061, China
  • Received:2022-06-21 Published:2023-02-01
  • Corresponding author: Ruimiao Bai
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李小龙, 彭飞, 邢虹, 张朋飞, 徐泉, 赵静儒, 李占魁, 郭金珍, 白瑞苗. 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[J]. 中华普通外科学文献(电子版), 2023, 17(01): 45-49,68.

Xiaolong Li, Fei Peng, Hong Xing, Pengfei Zhang, Quan Xu, Jingru Zhao, Zhankui Li, Jinzhen Guo, Ruimiao Bai. Regional cerebral oxygen saturation and regional intestinal oxygen saturation in early warning and surgical treatment of neonatal necrotizing enterocolitis[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(01): 45-49,68.

目的

研究局部脑氧饱和度（rcSO2）和局部肠道血氧饱和度（rintSO2）与新生儿坏死性小肠结肠炎（NEC）病情程度的关系，探讨rcSO2和rintSO2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rcSO2和rintSO2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rcSO2、rintSO2预测NEC发生和手术时机的价值。

结果

（1）疑似组和NEC组rcSO2及不同监测部位rintSO2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）。rcSO2及不同监测部位rintSO2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rcSO2<74.3%，右侧腹rintSO2<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rcSO2及不同监测部位rintSO2水平明显低于非手术组（t=2.341~4.815，P<0.05）。当rcSO2<72.4%，右侧腹rintSO2<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

rcSO2和rintSO2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。

关键词: 坏死性小肠结肠炎, 局部脑氧饱和度, 局部肠道血氧饱和度, 近红外光谱技术
Objective

To study the performance of regional cerebral oxygen saturation (rcSO2) and regional intestinal oxygen saturation (rintSO2) 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 August 2021 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 and 14 in the non-operation group. To observe the changes of rcSO2 and rintSO2 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 rcSO2 and rintSO2 in predicting the occurrence of NEC and the timing of surgery.

Results

(1) rcSO2 levels in the suspected group and NEC group and rintSO2 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). RcSO2 and rintSO2 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 rcSO2<74.3% and right abdominal rintSO2<75.4%, the area under curvec (AUC) of NEC and rintSO2 were 0.836 and 0.817 respectively, and the corresponding sensitivity and specificity were 78.8%, 84.8% and 81.8%, 76.9%, respectively, indicating high diagnostic efficiency. (2) RcSO2 and rintSO2 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 rcSO2<72.4% and right abdominal rintSO2<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 rcSO2 and rintSO2 levels are closely related to the severity of NEC in neonates. The application of near-infrared spectroscopy technology to monitor rcSO2 and rintSO2 levels has certain guiding value for early warning NEC and guiding the timing of surgical intervention.

Key words: Necrotizing enterocolitis, Regional cerebral oxygen saturation, Regional intestinal oxygen saturation, Near-infrared spectroscopy
表1 三组早产儿一般基线资料比较
组别 例数 性别(例) 胎龄(周) 出生体质量(kg) 入院日龄(d) 娩出方式(例)
男 女 自然分娩 剖宫产
对照组 49 30 19 29.8±2.3 1.3±0.2 15.3±2.4 34 15
疑似组 14 8 6 30.2±1.9 1.2±0.6 14.9±3.1 10 4
NEC组 33 19 14 30.5±2.0 1.3±0.1 15.1±2.7 22 11
统计值   χ2=0.143 t=1.066 t=0.804 t=0.147 χ2=0.123
P值   0.931 0.349 0.451 0.863 0.940
表2 三组早产儿rcSO2及不同监测部位rintSO2水平比较(%,±s)
组别 例数 rcSO2 rintSO2
上腹部 下腹部 左侧腹 右侧腹
对照组 49 78.3±5.1 81.8±4.8 79.6±5.4 81.5±5.7 82.6±5.9
疑似组 14 75.6±3.8 a 78.4±4.0 a 76.2±4.7 a 78.3±4.8 a 77.2±4.8 a
NEC组 33 72.2±2.9 ab 73.5±3.3 ab 72.7±4.0 ab 73.3±3.5 ab 71.9±3.7 ab
F值   20.028 38.000 19.952 27.393 43.865
P值   <0.001 <0.001 <0.001 <0.001 <0.001
表3 不同Bell分期与rcSO2和rintSO2水平比较(%,±s)
Bell分期 例数 rcSO2 rintSO2
上腹部 下腹部 左侧腹 右侧腹
Ⅰ期 14 75.6±3.8 78.4±4.0 76.2±4.7 78.3±4.8 77.2±4.8
Ⅱ期 13 73.7±3.9 75.3±3.6 a 74.3±4.1 75.0±4.0 a 73.7±4.1 a
Ⅲ期 20 71.2±2.2 ab 72.2±3.1 ab 71.6±3.7 ab 72.1±3.4 ab 70.6±3.6 ab
F值   7.801 12.866 5.298 9.828 10.934
P值   0.001 <0.001 0.009 <0.001 <0.001
表4 rcSO2和rintSO2水平与Bell分期的相关性
Bell分期 rcSO2 rintSO2
上腹部 下腹部 左腹侧 右腹侧
r值 -0.605 -0.612 -0.593 -0.609 -0.632
P值 <0.05 <0.05 <0.05 <0.05 <0.05
表5 手术组和非手术组NEC患儿rcSO2和rintSO2水平比较(%,±s)
组别 例数 rcSO2 rintSO2
上腹部 下腹部 左侧腹 右侧腹
非手术组 14 74.6±3.4 75.9±3.5 74.7±4.2 75.2±4.5 76.2±5.2
手术组 19 69.4±2.8 71.6±3.9 71.2±3.4 71.9±3.6 68.7±4.0
t值   4.815 3.066 2.645 2.341 4.688
P值   <0.001 0.003 0.013 0.026 <0.001
图1 局部脑氧饱和度（rcSO2）和局部肠道血氧饱和度（rintSO2）预测效能的ROC曲线分析　A为NEC发生；B为NEC手术治疗
[1]
Saroha V, Josephson CD, Patel RM. Epidemiology of necrotizing enterocolitis: new considerations regarding the influence of red blood cell transfusions and anemia[J]. Clin Perinatol, 2019, 46(1): 101-117.
[2]
王静. 新生儿坏死性小肠结肠炎发病机制研究进展[J]. 安徽医药, 2019, 23(6): 1074-1077.
[3]
周川, 冯百岁. 坏死性小肠结肠炎与新生儿脑损伤[J]. 中国实用神经疾病杂志, 2021, 24(5): 455-460.
[4]
Pasquini C. Near infrared spectroscopy: A mature analytical technique with new perspectives-A review[J]. Anal Chim Acta, 2018, 1026: 8-36.
[5]
Shadgan B, Pakravan AH, Hoens A, et al. Contrast baths, intramuscular hemodynamics, and oxygenation as monitored by near-infrared spectroscopy[J]. J Athl Train, 2018, 53(8): 782-787.
[6]
中华医学会小儿外科分会新生儿外科学组. 新生儿坏死性小肠结肠炎外科手术治疗专家共识[J]. 中华小儿外科杂志, 2016, 37(10): 724-728.
[7]
中国医师协会新生儿科医师分会循证专业委员会. 新生儿坏死性小肠结肠炎临床诊疗指南(2020)[J]. 中国当代儿科杂志, 2021, 23(1): 1-11.
[8]
张丙宏, 陶弯, 钟森, 等. 硫化氢提高肠道微循环灌注保护新生儿坏死性小肠结肠炎[J]. 中国现代医学杂志, 2017, 27(10): 40-46.
[9]
甘馨, 李娟. 新生儿坏死性小肠结肠炎研究进展[J]. 中国当代儿科杂志, 2018, 20(2): 164-169.
[10]
Hamrin TH, Radell PJ, Fläring U, et al. Performance of regional oxygen saturation monitoring by near-infrared spectroscopy (NIRS) in pediatric inter-hospital transports with special reference to air ambulance transports: A methodological study[J]. J Clin Monit Comput, 2018, 32(5): 841-847.
[11]
闵祥振, 贾智勇, 郭蕊, 等. 近红外光谱脑氧饱和度监测的临床应用进展[J]. 临床麻醉学杂志, 2020, 36(3): 307-310.
[12]
Zabaneh RN, Cleary JP, Lieber CA. Mesentric oxygen saturations in premature twins with and without necrotizing enterocolitis[J]. Pediatr Crit Care Med, 2011, 12(6): e404-e406.
[13]
毛建雄, 肖东, 罗燕, 等. 近红外光谱技术在测定新生儿坏死性小肠结肠炎脑血氧饱和度和判定肠坏死程度的探讨[J]. 岭南现代临床外科, 2020, 20(5): 562-566, 572.
[14]
马娜, Siddiqui Mohd Jaish, 夏斌. 新生儿坏死性小肠结肠炎发病机制的研究进展[J/CD]. 中华妇幼临床医学杂志（电子版）, 2020, 16(6): 739-744.
[15]
张敬华, 关瑞莲, 潘翩翩, 等. 极/超低出生体重儿生后早期腹部局部组织氧饱和度变化趋势的前瞻性研究[J]. 中国当代儿科杂志, 2021, 23(10): 1015-1020.
[16]
杨福江, 胡博. 新生儿坏死性小肠结肠炎的外科诊断与治疗[J]. 中国临床医生杂志, 2020, 48(2): 132-135.
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