无创经皮监测在氧疗新生儿中的应用

Application of transcutaneous monitoring in neonates treated with oxygen strategy

目的 :评价氧疗患儿经皮氧分压(TcPO_2)及二氧化碳分压(TcPCO_2)与动脉血氧分压(PaO_2)及二氧化碳分压(PaCO_2)的一致性及其影响因素,为无创监测在氧疗新生儿中的应用提供初步的指导依据。方法:收集氧疗新生儿的动脉血气值,并记录采集前后5 min内TcPO_2及TcPCO_2的平均值、体重、胎龄、脉搏(P)、吸入氧浓度、动脉血氧饱和度(SaO_2)、pH等,进行Pearson相关分析并运用受试者工作曲线(ROC)判断诊断价值。结果 :体重、吸入氧浓度等对TcPCO_2与PaCO_2在氧疗患儿中的相关性及一致性影响较小,循环障碍组TcPCO_2明显高于PaCO_2;TcPO_2与PaO_2的相关性稍差,在氧合指数较低及较高组两者无统计学相关,两者的差值随着出生体重的增大及动脉氧分压的增大而增加。结论:TcPCO_2与PaCO_2具有较好的相关性及一致性,尤其在极低出生体重儿,而TcPO_2与PaO_2相关性及一致性稍差,对于氧疗患儿,高氧分压下TcPO_2与PaO_2缺乏很好的相关性,在肺部氧合较差却无呼吸障碍表现时TcPO_2比PaO_2更能反映患儿的动脉氧合,对于指导氧疗新生儿的用氧更有价值。

Objective： To determine the consistency among TcPO2,TcPCO2,PaO2,PaCO2, in neonates treated with oxygen strategy,and to find the impact factors, in order to provide guidance for the transcutaneous monitoring as a substitute of blood gas analysis in neonates with oxygen strategy. Methods： We collected arterial blood gas of neonates during stable transcutaneous monitoring, and recorded TcPCO2 and TcPO25 min before and after collection, weight, pulse, gestational age, oxygen mode, fraction of inspired oxygen, arterial oxygen saturation（Sa O2）, and p H. Comparison was performed using descriptive statistics, Pearson correlation analysis and receiver operating characteristic（ROC） curve. Results： The factors including weight,inspired oxygen had no obvious impact on the consistency between TcPCO2 and PaCO2, and TcPCO2 was higher than PaCO2 in the cases with bad circulation. Statistical correlation and consistency was lower between TcPO2 and PaO2, especially in the lower oxygen index cases, there was no statistical correlation between them. The difference between TcPO2 and PaO2 was increased with the increase of birth weight and the increase of arterial oxygen partial pressure. Conclusion： TcPCO2 and PaCO2 have good consistency, even in very low birth weight. The correlation between TcPO2 and PaO2 is lower, for babies with oxygen strategy. There is no correlation between TcPO2 and PaO2 in high oxygen partial pressure, and TcPO2 is a better marker than PaO2 in revealing real arterial oxygenation, which is more valuable for the guidance of oxygen therapy in neonates.