足月新生儿重度呼吸衰竭动态氧合参数监测与预后

Relation between monitoring the dynamic oxygenated parameters and prognosis on sever respiratory failure in full-term neonates

目的探讨新生儿重度呼吸衰竭(severrespiratoryfailure,SRF)时动态氧合参数监测的临床意义。方法41例重度呼吸衰竭新生儿按临床转归分为死亡组(n=17)和生存组(n=24),回顾性分析两组通气治疗2h、12h、24h、36h的呼吸机参数和动脉血气值,并计算各时段的氧合指数(Pao2/Fio2)、肺泡—动脉血氧分压差(A—aDO2)、动脉血氧分压/肺泡氧分压(PaO2/PAO2)和呼吸指数(respirationindex,RI),进行组间和组内比较。结果死亡组在呼吸机参数明显或逐步高于生存组的情况下,36h的PaO2才低于生存组(P<0.05),但组内比较都无显著差异(P>0.05)。死亡组24h、36h的PaO2/FiO2低于生存组(P<0.01);12h,24h,36h的A-aDO2高于生存组(P<0.05或0.01);12h,24h,36h的PaO2/PAO2低于生存组(P<0.05或0.01);24h、36h的RI高于生存组(P<0.01)。生存组各时段的PaO2/FiO2和PaO2/PAO2顺次增大;A—aDO2和RI顺次减小,均有显著差异(P<0.05或0.01),死亡组组内则都无变化(P>0.05)。结论在新生儿重度呼吸衰竭的早期,PaO2不是评估预后的有效指标,PaO2/FiO2、A—aDO2、PaO2/PAO2和RI更能反映肺损伤的程度、氧交换率和治疗效果,其中A—aDO2和PaO2/PAO2最为敏感,动态监测可帮助判断预后。

Objective To investigate the clinical signicnace of monitoring the dynamic oxygenated parameters in fun-term neonates with severe respiratory failure. Methods Forty-one fun-term neonates with SFR were divided into two groups according to the treatment outcome： the death group（n=17） and the survival group （n=24）. the parameters of breathing machine and arterial blood gas analysis of two groups at 2h, 12h, 24h and 36h after mechanical ventilation were analyzed retrospectively. PaO2/FiO2, A-aDO2, PaO2/PAO2 and RI at the same respective period were calculated and then the results were compared between two groups and within each group. Results Under the circumtance that parameters on breathing machine in the death group were obviously or gradually higher than those in the survival group, PaO2 in the death group was lower than that in the survival group only at 36h （P〈0.05）, but within each group, PaO2 in each period had no significant difference （P〉 0.05）. In the death group, PaO2/FiO2 at 24h and 36h was lower than that in the survival group（P〈O.Ol）; A-a-DO2 at 12h, 24h and 36h was higher than that in the survival group（P〈0.05 or 0.01）; PaO2/PAO2 at 12h, 24h and 36h was lower than that in the survival group（P〈0.05 or 0.01） and RI 24h and 36h （5.75±1.86 and 5.90± 2.33）was higher than that in the survival group（4.19±1.86 and 3.21±1.40） （P〈0.01）. In the survival group, PaO2/ FiO2 and PaO2/P^O： were increasing gradually in order in each period; A-aDO2 and RI were decreasing gradually, and highly significant differences were found（P〈0.05 or 0.01）. In the death group, they showed no difference （P〉0.05）. Conclusions PaO2 is not the sensitive parameter on prognostic assessment in the first stages of full-term neonates with ARDS. PaO2/FiO2, A-aDO2, PaO2/PAO2 and RI are better than PaO2 to reflect the degree of lung injury, oxygen crossover rates and therapeutic efficacy. A-aDO2 and PaO2/PAO2 are especially sensitive for assessing early therapeutic reaction of SFR in full-term neonates, and their dynamic states may be helpful for judging prognosis.