动态监测血氧灌注指数对足月儿窒息伴休克复苏的评价意义

The significance of dynamic monitoring of perfusion index in recovery of term infants with asphyxiation and shock

目的:探讨血氧灌注指数(PI)值在足月新生儿窒息伴休克复苏中的变化及其临床意义。方法:选取2016年10月至2017年12月东南大学附属中大医院无锡分院足月窒息新生儿65例,按新生儿休克评分分为窒息休克组(24例)及窒息非休克组(41例),均在出生时及治疗2、24、48h时测定其PI值;选取同期正常足月新生儿50例作为对照组,均在出生时及出生后2、24、48h时测定其PI值。对各组PI值进行分析比较,并记录患儿预后情况。结果:窒息休克组出生时的PI值低于窒息非休克组(P<0.05),亦低于对照组(P<0.05),窒息非休克组出生时PI值也低于对照组(P<0.05);随着病情严重程度增加,休克新生儿PI值明显下降;窒息休克组经复苏及抗休克治疗、窒息非休克组经复苏及其他综合治疗2h及24h的PI值较出生时有改善,但与对照组相比差异仍有统计学意义(P<0.05);至生后48h,两组的PI值与对照组比较差异无统计学意义(P>0.05)。结论:足月新生儿发生窒息时其PI值明显下降,如伴有休克则PI值的下降更加明显,临床上如PI值反复难以纠正,则应注意是否伴有休克因素的存在。

Objective: To study the variation and clinical meaning of perfusion index(PI) in recovery of term infants with asphyxiation and shock. Methods: 65 cases of term asphyxiating newborn in our hospital from October,2016 to December,2017 were selected,and according to the neonatal shock score, the patients were divided into the shock group( n =24 cases) and the non-shock group( n =41 cases), and all patients were treated with 2 h, 24 h and 48 h, and their PI values were measured.50 cases of normal full-term newborns in the same period were selected as the control group,the PI values were measured at birth, postnatal 2 h, 24 h and 48 h.Then,the PI values of each group were analyzed and compared, and their prognosis was recorded. Results: The PI value of the shock group was lower than that of the non-shock group at birth( P <0.05) and was lower than that of the control group ( P <0.05). The PI value of the non-shock group was lower than that of the control group at birth( P <0.05).With the increase of the severity of the disease, the PI values of neonatal shock were decreased significantly.With the recovery of asphyxia and shock treatment and the other comprehensive treatment,the PI values of 2 h and 24 h were improved,but compared with the control group there was still statistical difference( P <0.05).To 48 h after birth,compared with the control group there were no statistical differences in the two groups PI values( P >0.05). Conclusion: The PI value decreases significantly when the newborn is asphyxiated,and the decrease of the PI value is more obvious when there is shock.The repeated difficulty in correcting clinical factors such as PI suggests that we should pay attention to the presence of shock factors.