胎儿窘迫后新生儿脑组织氧饱和度研究

目的探讨胎儿窘迫与新生儿脑组织氧饱和度(rSO2)的关系及围生期缺氧并发脑损伤时新生儿脑组织rSO2的变化。方法将胎儿窘迫后娩出的足月新生儿135例根据缺氧缺血性脑病(HIE)诊断标准分为HIE组(62例)和无HIE组(73例),无胎儿窘迫娩出的30例足月新生儿为对照组,在新生儿出生后2～8 h及第2天、第3天、第5天、第7天应用TSAH-100型近红外组织血氧参数无损监测仪测量脑组织rSO2。结果HIE组新生儿出生后2～8 h、第2天、第3天、第5天、第7天脑组织rSO2均低于对照组(P<0.05);无HIE组新生儿出生后2～8 h、第2天、第3天脑组织rSO2均低于对照组(P<0.05);HIE组新生儿出生后2～8 h、第2天、第3天脑组织rSO2低于无HIE组(P<0.05)。胎儿窘迫后剖宫产组新生儿出生后第2天脑组织rSO2较顺产组低(P<0.05),其余各组间比较差异无显著性意义(P>0.05)。结论HIE患儿在宫内缺氧时间较长,有脑内氧合及细胞代谢异常;无HIE组的新生儿宫内缺氧程度轻,新生儿没有因严重缺氧导致脑损伤。胎儿窘迫的分娩方式与新生儿脑组织rSO2无直接关系,熟练的钳产手术不增加胎儿脑损伤。

Study on brain tissue oxygen saturation in neonates with fetal distress

Objective To investigate the relation between fetal distress and brain tissue oxygen saturation(rSO2) of neonates,and the change of rSO2 of neonatus with hypoxia in perinatal stage combining with brain injured.Methods 135 cases of full-term newborn with fetal distress were divided into two groups according to the diagnostic criteria of hypoxic-ischemic encephalopathy(HIE),the HIE group(62 cases) and no HIE group(73 cases).full-term newborn with no fetal distress were assigned as control group.Brain tissue rSO2 was measured by Near-infrared spectroscope on postnatal 2～8 h,the 2nd,3rd,5th,7th day.Results Brain tissue rSO2 in HIE group was lower than the control group(P<0.05)on postnatal 2-8 h and the 2nd,3rd,5th,7th day.Brain tissue rSO2 in no HIE group was lower than control group on postnatal 2～8 h and the 2nd,3rd day and Brain tissue rSO2 in HIE group was lower than no HIE group on 2～8 h and the 2nd,3rd day.Brain tissue rSO2 of neonates with uterine-incision delivery and fetal distress was lower than the spontaneous labor levels on the second day(P<0.05).There was no obvious difference among three groups(P>0.05).Conclusion Neonates with HIE are complicated with oxygenation and cell metabolic disorders because of hypoxia for long time in uterus.There is no cerebral damage due to serious hypoxia.There is no direct relationship between the way of delivery for distressed fetus and neonatal brain tissue oxygen saturation level.Skilled delivery with forceps doesn't increase the risk of fetal brain injured.