新生儿输注红细胞期间肠道氧合与肠系膜上动脉血流动力学变化的相关性分析：一项前瞻性队列研究

doi:10.12372/jcp.2026.25e1436

摘要/Abstract

摘要：

目的探讨输注红细胞过程中新生儿肠道组织氧饱和度与肠系膜上动脉血流动力学参数的动态变化及相关性。方法连续选取2024年10月至2025年10月新生儿重症监护病房收治需输注红细胞治疗的新生儿，在输注前1小时（t_－1h）、输注中期（t_m）、输注末期（t_e）及输注结束后2小时（t_2h）、4小时（t_4h）、12小时（t_12h）、24小时（t_24h）、48小时（t_48h）共8个时间点同步监测肠道组织氧饱和度（SrSO₂）及肠系膜上动脉收缩期峰值流速（PSV）、舒张末期流速（EDV）并计算阻力指数（RI）。采用Spearman相关性分析、广义估计方程及交叉滞后相关分析探讨指标间关联。结果共纳入符合条件的患儿43例，其中男性26例（60.5%），出生胎龄31.1（29.0~36.0）周，出生体重1 750（1 255~2 600）g；不同时间点中位PSV波动于33.4~46.9 cm/s，中位EDV波动于9.6~11.5 cm/s，中位RI波动于0.73~0.77，中位SrSO₂波动于49.8%~56.5%。相关性分析显示，仅t_4h时间点的RI与SrSO₂存在显著负相关（r_s=－0.52，P_校正后=0.048），其余时间点各血流参数与SrSO₂均无显著相关性（P均>0.05）。广义估计方程显示时间因素对PSV（β=0.003，P=0.992）、EDV（β=－0.073，P=0.449）、RI（β=0.002，P=0.324）均无显著影响，对SrSO₂的影响具有统计学意义（β=0.776，P=0.004）。PSV、EDV、RI与SrSO₂的平均互相关函数（CCF）绝对值均较小（最高为PSV在－1阶的0.151），未呈现明显的滞后关联规律。结论在新生儿红细胞输注过程中，肠系膜上动脉宏观血流动力学参数相对稳定，而SrSO₂总体有升高趋势；两者变化无明显同步或滞后关联，提示宏观血流与微循环氧合可能受到不同调节机制的调控。

关键词: 输血, 肠道氧合, 肠系膜上动脉, 血流动力学, 相关性分析, 新生儿

Abstract:

Objective To investigate the dynamic changes and correlation between splanchnic tissue oxygen saturation (SrSO₂) and superior mesenteric artery (SMA) hemodynamic parameters in neonates during red blood cell (RBC) transfusion. Methods A total of neonates who required RBC transfusion and were admitted to the neonatal intensive care unit between October 2024 and October 2025 were enrolled in this study. Synchronous monitoring of SrSO₂ and SMA hemodynamic parameters — including peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) — was performed at eight predefined time points: 1 hour before transfusion (t_-1h), mid-transfusion (t_m), end of transfusion (t_e), and 2, 4, 12, 24, and 48 hours after transfusion completion (t_2h, t_4h, t_12h, t_24h, and t_48h). Spearman correlation, generalized estimating equations (GEE), and cross-lagged correlation analyses were used to examine the associations among the indicators. Results A total of 43 neonates were included, with 26 boys (60.5%). The median gestational age was 31.1 (29.0-36.0) weeks and the median birth weight was 1750 (1255-2600) g. During the observation period, the median PSV ranged from 33.4 to 46.9 cm/s, median EDV from 9.6 to 11.5 cm/s, median RI from 0.73 to 0.77, and median SrSO₂ from 49.8% to 56.5%. Correlation analysis revealed a significant negative correlation only at t4h between RI and SrSO₂ (r_s=-0.52, P_adjusted=0.048); no significant correlations were found at other time points (all P>0.05). GEE showed that time had no significant effect on PSV (β=0.003, P=0.992), EDV (β=-0.073, P=0.449), or RI (β=0.002, P=0.324), but had a statistically significant positive effect on SrSO₂ (β=0.776, P=0.004). The absolute values of the mean cross-correlation function (CCF) between PSV, EDV, RI and SrSO₂ were all small (the highest was 0.151 for PSV at lag-1), indicating no clear lagged relationship. Conclusions During RBC transfusion in neonates, the SMA hemodynamic parameters remain relatively stable, whereas the SrSO₂ shows an overall increasing trend. There is no significantly synchronous or lagged correlation between the changes in these two measures, suggesting that macrohemodynamics and microcirculatory oxygenation may be regulated by different mechanisms.

Key words: blood transfusion, splanchnic oxygenation, superior mesenteric artery, hemodynamics, correlation analysis, neonate

中图分类号:

黄海婷, 张慧, 阿尔孜古丽·托合提, 苏雅洁, 李龙. 新生儿输注红细胞期间肠道氧合与肠系膜上动脉血流动力学变化的相关性分析：一项前瞻性队列研究[J]. 临床儿科杂志, 2026, 44(4): 323-330.

HUANG Haiting, ZHANG Hui, TUOHETI Aerziguli, SU Yajie, LI Long. Correlation between splanchnic tissue oxygen saturation and superior mesenteric artery hemodynamics during red blood cell transfusion in neonates: a prospective cohort study[J]. Journal of Clinical Pediatrics, 2026, 44(4): 323-330.

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项目	结果
男性[n(%)]	26(60.5)
胎龄[M(P₂₅~P₇₅)]/周	31.1(29.0~36.0)
出生体重[M(P₂₅~P₇₅)]/g	1 750(1 255~2 600)
1分钟Apgar评分[n(%)]
>7分	24(55.8)
4~7分	15(34.9)
0~3分	4(9.3)
输血时日龄[M(P₂₅~P₇₅)]/d	17.0(12.0~23.0)
输血时体重($\bar{x}±s$)/g	2 101±769
输血前Hb($\bar{x}±s$)/g·L^-1	98.3±12.6
贫血程度[n(%)]
轻度贫血	24(55.8)
中度贫血	19(44.2)
输血前Hct($\bar{x}±s$)/%	28.7±3.7
呼吸支持[n(%)]
无	13(30.2)
无创通气(鼻导管/CPAP)	12(27.9)
有创机械通气	18(41.9)
动脉导管未闭[n(%)]	3(7.0)
输血前喂养状态[n(%)]
禁食	11(25.6)
经口/鼻饲喂养	32(74.4)
配方奶	28
母乳	4
总奶量[M(P₂₅~P₇₅)]/mL·kg^-1·d^-1	78.3(20.8~126.8)

项目	t_－1h	t_m	t_e	t_2h	t_4h	t_12h	t_24h	t_48h
PSV/cm·s^-1	40.7 (36.3~53.9)	43.9 (35.2~54.0)	43.6 (30.4~50.6)	46.9 (37.2~53.8)	46.4 (32.7~54.8)	44.1 (37.6~55.5)	33.4 (29.9~50.1)	34.2 (28.4~50.5)
EDV/cm·s^-1	11.5 (8.5~14.0)	11.2 (8.4~14.0)	9.6 (8.3~12.4)	10.1 (8.5~12.2)	10.2 (8.0~12.6)	10.2 (8.1~13.2)	10.2 (7.6~12.0)	10.9 (8.3~12.2)
RI	0.7 (0.7~0.8)	0.7 (0.7~0.8)	0.7 (0.7~0.8)	0.8 (0.7~0.8)	0.8 (0.7~0.8)	0.8 (0.7~0.8)	0.7 (0.7~0.8)	0.7 (0.7~0.8)
SrSO₂/%	52.5 (39.2~56.0)	49.8 (40.1~56.7)	55.5 (50.2~61.0)	53.3 (47.8~55.3)	55.1 (48.2~58.3)	54.2 (44.5~56.2)	56.5 (50.7~61.0)	56.2 (47.3~61.2)