“30-60—90”规则在新生儿氧疗中的应用

Application of ＂30 -60 -90＂ rule in neonatal oxygen therapy

目的观察采用“30-60—90”规则滴定调节新生儿吸人氧浓度的相关指标变化。方法选择需要吸氧的新生儿100例，其中早产儿50例，足月儿50例，用脉搏血氧饱和度监测仪监测脉搏血氧饱和度（SpO2）；采用“30—60—90”规则按照目标SpO2滴定调节吸入氧浓度，稳定半小时后进行血气分析；计算符合要求的调节成功率，用双变量相关分析对SpO2和动脉血氧饱和度（SaO2）、动脉血氧分压（PaO2）进行相关性分析。结果达到PaO2目标范围的调节成功率早产儿为88％，足月儿为92％，平均为90％。经相关分析，早产儿组SpO2和SaO2，以及SpO2和PaO2之间均存在正相关关系（r值分别为0．765，0．593；P=0．000）；足月儿组SpO2和SaO2，以及SpO2和PaO2之间均存在正相关关系（r值分别为0．778，0．726；P=0．000）。早产儿SpO2和SaO2数值均低于足月儿，差异有统计学意义（z值分别为-3．175，-2．409；P〈0．05）；两组之间PaO2数值比较差异无统计学意义（P〉0．05）。结论“30—60-90”规则是十分方便和有效的床边指导新生儿氧疗的规则，值得推广实施。

Objective -＂To observe the change of relevant indicators in titrating neonatal fraction of inspired oxygen（FiO2） for the target SpO2 according to the ＂30 -60 -90＂rule. Methods 100 neonates with anoxia neonatorum were randomly selected and divided into premature group （50 cases） and mature group （50 cases）. Pulse oximeter was used to monitor the pulse oximetry saturation （SpO2 ） and ＂30-60 -90＂ rule was used to titrate FiO2 for the target SpO2. Blood gas was analyzed haft an hour after the SpO2 was stable. The success rate was calculated and double variables were used to analyze the value of arterial oxygen tension （PaO2）, SpO2 and arterial oxygen saturation （SaO2 ） statistically. Results The success rate to reach the target range of PaO2 was 90%, in which the premature group was 92% and the mature group was 88%. According to the correlation analysis, there was positive correlation between SpO2 and SaO2 in premature group （ r = 0. 765, P = 0.000） and mature group （ r = 0. 778, P = 0. 000）, and between Sp02 and PaO2 in premature group （ r = O. 593, P =0.000） and mature group（ r =0.726 ,P =0.000）. The SpO2 and PaO2 of the premature group were lower than that of the mature group, and the differences were statistically significant （ Z = - 3. 175, - 2. 409, respectively; P 〈 0.05）. There was no significant difference of PaO2 , however, between the premature group and the mature group （P 〉 0.05）. Conclusions The ＂30 - 60 - 90＂ rule is a very convenient and effective bedside guideline for neonatal oxygen therapy, which is worthy in clinical promotion and implementation.