应用近红外光谱技术监测脓毒症患儿胃肠功能障碍的前瞻性研究

姚德贞; 王丽杰

doi:10.7499/j.issn.1008-8830.2202099

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中国当代儿科杂志 ›› 2022, Vol. 24 ›› Issue (6) : 620-625. DOI: 10.7499/j.issn.1008-8830.2202099

论著·临床研究

应用近红外光谱技术监测脓毒症患儿胃肠功能障碍的前瞻性研究

姚德贞, 王丽杰

作者信息 +

Monitoring of gastrointestinal dysfunction by near-infrared spectroscopy in children with sepsis: a prospective study

YAO De-Zhen, WANG Li-Jie

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摘要

目的探讨脓毒症患儿胃肠功能障碍的发生率、病死率，应用近红外光谱技术（near-infrared spectroscopy，NIRS）监测肠系膜局部组织血氧饱和度（regional oxygen saturation，rSO₂），观察胃肠功能障碍患儿rSO₂差异。方法前瞻性选择2021年1~12月儿科重症监护病房79例脓毒症患儿（脓毒症组）及儿童保健科40例健康体检儿童（健康对照组）为研究对象，收集患儿入院及出院基本情况、在院治疗情况和实验室检查指标，应用NIRS测定肠系膜rSO₂，根据有无胃肠功能障碍发生进行组间对比。结果 79例脓毒症患儿胃肠功能障碍发生率为49%（39/79），胃肠功能障碍患儿28 d病死率为26%（10/39）。胃肠功能障碍患儿机械通气时间更长、28 d病死率更高（P<0.05）。胃肠功能障碍患儿肠系膜rSO₂（64%）低于无胃肠功能障碍患儿（72%）及健康对照组（78%）（P<0.05）。结论脓毒症患儿胃肠功能障碍发生率及病死率较高，影响患儿预后。肠系膜rSO₂的降低与胃肠功能障碍发生相关。

Abstract

Objective To investigate the incidence and mortality of gastrointestinal dysfunction in children with sepsis, the application of near-infrared spectroscopy (NIRS) in monitoring mesenteric regional tissue oxygen saturation (rSO₂), and the association between rSO₂ and gastrointestinal dysfunction. Methods In this prospective study, 79 children with sepsis in the pediatric intensive care unit (sepsis group) and 40 children who underwent physical examination in the Department of Child Healthcare (healthy control group) from January to December, 2021 were enrolled as subjects. The related medical data were collected, including general information on admission and at discharge, treatment during hospitalization, and laboratory examination results. NIRS was used to measure mesenteric rSO₂. Clinical characteristics were compared between the patients with and without gastrointestinal dysfunction. Results For the 79 children with sepsis, the incidence rate of gastrointestinal dysfunction was 49% (39/79), and the mortality rate of the children with gastrointestinal dysfunction was 26% (10/39). The children with gastrointestinal dysfunction had a longer duration of mechanical ventilation and a higher 28-day mortality rate (P<0.05). The children with gastrointestinal dysfunction had a significantly lower median rSO₂ (64%) than the children without gastrointestinal dysfunction (72%) and the healthy control group (78%) (P<0.05). Conclusions There are high incidence and mortality rates of gastrointestinal dysfunction in children with sepsis, and the reduction in rSO₂ may be associated with the development of gastrointestinal dysfunction.

导出引用

姚德贞, 王丽杰. 应用近红外光谱技术监测脓毒症患儿胃肠功能障碍的前瞻性研究[J]. 中国当代儿科杂志. 2022, 24(6): 620-625 https://doi.org/10.7499/j.issn.1008-8830.2202099

YAO De-Zhen, WANG Li-Jie. Monitoring of gastrointestinal dysfunction by near-infrared spectroscopy in children with sepsis: a prospective study[J]. Chinese Journal of Contemporary Pediatrics. 2022, 24(6): 620-625 https://doi.org/10.7499/j.issn.1008-8830.2202099

参考文献

1 Reintam Blaser A, Jakob SM, Starkopf J. Gastrointestinal failure in the ICU[J]. Curr Opin Crit Care, 2016, 22(2): 128-141. PMID: 26835609. DOI: 10.1097/MCC.0000000000000286.
2 Klingensmith NJ, Coopersmith CM. The gut as the motor of multiple organ dysfunction in critical illness[J]. Crit Care Clin, 2016, 32(2): 203-212. PMID: 27016162. PMCID: PMC4808565. DOI: 10.1016/j.ccc.2015.11.004.
3 章玉丹, 沙移飞, 李华, 等. 急性胃肠功能衰竭患儿急诊和治疗的临床分析[J]. 河北医药, 2017, 39(1): 113-115. DOI: 10.3969/j.issn.1002-7386.2017.01.035.
4 中华医学会儿科学会急救学组. 第四届全国小儿急救医学研讨会纪要[J]. 中华儿科杂志, 1995, 33(6): 370-373.
5 Lo MY, Ong MW, Chen WY, et al. The effects of acupuncture on cerebral and muscular microcirculation: a systematic review of near-infrared spectroscopy studies[J]. Evid Based Complement Alternat Med, 2015, 2015: 839470. PMID: 26221180. PMCID: PMC4480930. DOI: 10.1155/2015/839470.
6 Gumulak R, Lucanova LC, Zibolen M. Use of near-infrared spectroscopy (NIRS) in cerebral tissue oxygenation monitoring in neonates[J]. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2017, 161(2): 128-133. PMID: 28360433. DOI: 10.5507/bp.2017.012.
7 Goldstein B, Giroir B, Randolph A, et al. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics[J]. Pediatr Crit Care Med, 2005, 6(1): 2-8. PMID: 15636651. DOI: 10.1097/01.PCC.0000149131.72248.E6.
8 Padar M, Starkopf J, Uusvel G, et al. Gastrointestinal failure affects outcome of intensive care[J]. J Crit Care, 2019, 52: 103-108. PMID: 31035184. DOI: 10.1016/j.jcrc.2019.04.001.
9 Reintam A, Parm P, Kitus R, et al. Gastrointestinal failure score in critically ill patients: a prospective observational study[J]. Crit Care, 2008, 12(4): R90. PMID: 18625051. PMCID: PMC2575570. DOI: 10.1186/cc6958.
10 季娟娟, 孙耕耘. 降钙素原和常用炎症指标在脓毒症诊断及预后中的价值[J]. 中华肺部疾病杂志(电子版), 2015, 8(4): 4-8. DOI: 10.3877/cma.j.issn.1674-6902.2015.04.002.
11 Kowlgi NG, Chhabra L. D-lactic acidosis: an underrecognized complication of short bowel syndrome[J]. Gastroenterol Res Pract, 2015, 2015: 476215. PMID: 25977687. PMCID: PMC4421027. DOI: 10.1155/2015/476215.
12 Kong C, Li SM, Yang H, et al. Screening and combining serum biomarkers to improve their diagnostic performance in the detection of intestinal barrier dysfunction in patients after major abdominal surgery[J]. Ann Transl Med, 2019, 7(16): 388. PMID: 31555702. PMCID: PMC6736800. DOI: 10.21037/atm.2019.07.102.
13 Lei G, Zhang J, Wang X, et al. Plasma D-lactate levels in necrotizing enterocolitis in premature infants[J]. Iran J Pediatr, 2016, 26(2): e4403. PMID: 27307969. PMCID: PMC4906561. DOI: 10.5812/ijp.4403.
14 Duzgun AP, Bugdayci G, Sayin B, et al. Serum D-lactate: a useful diagnostic marker for acute appendicitis[J]. Hepatogastroenterology, 2007, 54(77): 1483-1486. PMID: 17708281.
15 Shi H, Wu B, Wan J, et al. The role of serum intestinal fatty acid binding protein levels and D-lactate levels in the diagnosis of acute intestinal ischemia[J]. Clin Res Hepatol Gastroenterol, 2015, 39(3): 373-378. PMID: 25683524. DOI: 10.1016/j.clinre.2014.12.005.
16 Teng J, Xiang L, Long H, et al. The serum citrulline and D-lactate are associated with gastrointestinal dysfunction and failure in critically ill patients[J]. Int J Gen Med, 2021, 14: 4125-4134. PMID: 34377012. PMCID: PMC8349205. DOI: 10.2147/IJGM.S305209.
17 彭昊, 龙博文, 肖晨, 等. 重症监护室患儿血清胃泌素和胃动素指标的变化及意义研究[J]. 中国全科医学, 2021, 24(32): 4094-4098. DOI: 10.12114/j.issn.1007-9572.2021.01.025.
18 Minhua C, Tao G, Fengchan X, et al. Using digestive fluid biomarkers to predict acute gastrointestinal injury in critically ill patients: a pilot study[J]. Am J Crit Care, 2018, 27(6): 504-507. PMID: 30385542. DOI: 10.4037/ajcc2018255.
19 唐晓梦, 任玉倩, 熊熙, 等. 成纤维细胞生长因子19预测儿童脓毒症合并胃肠功能障碍的临床价值[J]. 上海交通大学学报(医学版), 2020, 40(9): 1236-1242. DOI: 10.3969/j.issn.1674-8115.2020.09.012.
20 Al Tayar A, Abouelela A, Mohiuddeen K. Can the cerebral regional oxygen saturation be a perfusion parameter in shock?[J]. J Crit Care, 2017, 38: 164-167. PMID: 27915164. DOI: 10.1016/j.jcrc.2016.11.006.
21 Ghidini F, Benetti E, Zucchetta P, et al. Transcutaneous near-infrared spectroscopy (NIRS) for monitoring kidney and liver allograft perfusion[J]. Int J Clin Pract, 2021, 75(5): e14034. PMID: 33470001. DOI: 10.1111/ijcp.14034.
22 Dorum BA, Ozkan H, Cetinkaya M, et al. Regional oxygen saturation and acute kidney injury in premature infants[J]. Pediatr Int, 2021, 63(3): 290-294. PMID: 32634851. DOI: 10.1111/ped.14377.
23 Jones S, Chiesa ST, Chaturvedi N, et al. Recent developments in near-infrared spectroscopy (NIRS) for the assessment of local skeletal muscle microvascular function and capacity to utilise oxygen[J]. Artery Res, 2016, 16: 25-33. PMID: 27942271. PMCID: PMC5134760. DOI: 10.1016/j.artres.2016.09.001.
24 Huang J, Zhou Y, Zhu D. Systemic haemodynamics and regional tissue oxygen saturation after bidirectional cavopulmonary shunt: positive pressure ventilation versus spontaneous breathing[J]. Interact Cardiovasc Thorac Surg, 2016, 23(2): 235-239. PMID: 27165735. DOI: 10.1093/icvts/ivw126.
25 Scott JP, Hoffman GM. Near-infrared spectroscopy: exposing the dark (venous) side of the circulation[J]. Paediatr Anaesth, 2014, 24(1): 74-88. PMID: 24267637. DOI: 10.1111/pan.12301.
26 Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA, 2016, 315(8): 801-810. PMID: 26903338. PMCID: PMC4968574. DOI: 10.1001/jama.2016.0287.
27 Stienstra RM, McHoney M. Near-infrared spectroscopy (NIRS) measured tissue oxygenation in neonates with gastroschisis: a pilot study[J]. J Matern Fetal Neonatal Med, 2021, 1-9. PMID: 33602021. DOI: 10.1080/14767058.2021.1875429. Epub ahead of print.
28 Patel AK, Lazar DA, Burrin DG, et al. Abdominal near-infrared spectroscopy measurements are lower in preterm infants at risk for necrotizing enterocolitis[J]. Pediatr Crit Care Med, 2014, 15(8): 735-741. PMID: 25068253. DOI: 10.1097/PCC.0000000000000211.
29 Kaufman J, Almodovar MC, Zuk J, et al. Correlation of abdominal site near-infrared spectroscopy with gastric tonometry in infants following surgery for congenital heart disease[J]. Pediatr Crit Care Med, 2008, 9(1): 62-68. PMID: 18477915. DOI: 10.1097/01.PCC.0000298640.47574.DA.