摘要
近期发现在肌肤相亲护理(SSC)时,体温升高的同时心动过缓和低血氧饱和度的发生率也增加。为确定这些效应之间有无相关性,监测了22名婴儿3次2 h的呼吸运动、鼻气流、心率以及脉搏氧饱和度(SpO2)。受试婴儿出生时的中位胎龄为28.5周(极差24-31周),监测时中位年龄为25.5 d(极差10-60 d),中位出生体重为1 025g(极差550-1 525g),研究时的中位体重为1 320 g(极差900-2 460 g)。将其分为3组:在暖箱护理时保持热平衡(NT)组,在SSC时保持NT组以及在暖箱里保持较高的温度(ET)组。通过直肠探针对婴儿的核心温度进行测量。对记录的心动过缓、低血氧饱和度的数据进行分析,结果显示,心率【基线的2/3,SpO2≤80%。直肠温度在SSC时无变化,在ET时升高0.6 ℃(P【0.001)。心动过缓和低血氧饱和度的结果在SSC 时有所增加,而在ET时无变化[TN:M=2.2/h(极差0-19);高温时,平均1.7/h(极差0-13);SSC时,平均3.0/h(极差0-25),SSC组与ET组比较,P【0.02]。在SSC时,甚至在直肠温度不变的情况下,心动过缓和低血氧饱和度也增加了,而ET对呼吸运动、鼻气流、心率以及脉搏氧饱和度没有影响。适度的体温升高不会增加早产儿呼吸的不稳定性。
We recently found increased temperature and increased bradycardia and desaturation during skin-to-skin care (SSC) . We wanted to determine if these effects were related. Twenty-two infants (median gestational age at birth 28. 5 weeks [range 24 - 31], median age at study 25. 5 days [range 10-60 days], median birth weight 1025 g [range 550-1525 g], median weight at study 1320 g [range 900 - 2460 g] ) underwent three 2 - hour recordings of breathing movements, nasal airflow, heart rate, and pulse oximeter saturation (SpO2): at thermoneutrality (TN) during incubator care, at TN during SSC, and at elevated temperature (ET) during incubator care. Core temperature was measured via a rectal probe. Recordings were analyzed for the summed rate of bradycardia and de-saturation (heart rate <2/3 of baseline; SpO2≤80% ) . Rectal temperature remained unchanged during SSC and increased by 0. 6° Cduring ET (P < . 001) . The summed rate of bradycardia and desaturation was increased during SSC but not during ET (TN: median 2. 2/hour (range, 0-19), ET: median 1. 7/hour (range, 0-13), SSC: 3.0/hour (0-25), P < . 02 SSC vs ET) . Bradycardia and desaturation were increased during SSC, even at constant rectal temperature, whereas ET had no effect on these events. Moderate hyperthermia did not increase respiratory instability in preterm infants.
