3-导心电图与脉搏血氧饱和度仪在高危新生儿生后早期心率评估中的应用

3-lead electrocardiography and pulse oximetry in early heart rate assessment of high-risk neonates

目的比较应用3-导心电图(electrocardiography,ECG)与脉搏血氧饱和度仪(pulse oximetry,POX)测量新生儿生后早期心率的准确性和及时性。方法采用前瞻性研究。选择2019年10月至2020年8月西安市人民医院(西安市第四医院)经剖宫产分娩的新生儿中胎龄≥37周、出生体重>1500 g、经快速评估不需要复苏的高危新生儿共42例为研究对象。新生儿擦干后立即同时连接POX和3-导ECG,之后持续监测生后10 min内心率情况。所有操作过程及数据监测均由摄像机记录,研究完成后由专人分析视频资料。比较2种方法连接设备所用时间、获得可靠心率的时间、连接设备至获得可靠心率总时间、出生至获得可靠心率总时间、生后5 min内经设备获得可靠心率的新生儿比例以及2种设备同时测得可靠心率读数的一致性。采用Wilcoxon符号秩和检验、配对样本χ^(2)检验、Spearman相关性分析、组内相关系数检验和Bland-Altman法进行统计学分析。结果连接POX与3-导ECG所用中位时间分别为13.0 s(10.0~17.0 s)与23.0 s(18.0~28.3 s);POX与3-导ECG获得可靠心率的中位时间分别为79.5 s(56.2~128.0 s)与11.0 s(10.0~13.3 s),自连接设备至获得可靠心率总时间分别为92.0 s(71.3~139.0 s)与35.0 s(30.0~39.5 s),新生儿出生至获得可靠心率的总时间分别为110.5 s(85.8~153.5 s)与52.0 s(45.0~66.3 s),差异均有统计学意义(Z值分别为-5.050、-5.646、-5.579和-5.579,P值均<0.001)。生后1 min内POX与3-导ECG检测到可靠心率的新生儿比例分别为2.4%(1/42)与69.1%(29/42)。生后60 s、90 s、120 s和150 s时3-导ECG检测到可靠心率的新生儿比例均高于POX(P值均<0.001),生后5 min内其他时间点3-导ECG检测到可靠心率的新生儿比例亦高于POX,但差异无统计学意义(P值均>0.05)。生后10 min内3-导ECG与POX测得心率数值中位数分别为161次/min(147~175次/min)和160次/min(146~176次/min),Spearman相关系数为0.966(P<0.001)。2种方法检测心率平均差为0.56次/min,95%CI为-4.3~5.4次/min,组内相关系数为0.961,一致性良好。结论3-导ECG在生后1 min内即可准确评估高危新生儿心率,远早于POX,复苏时可考虑应用3-导ECG持续监测新生儿心率。

Objective To compare the accuracy and timeliness of 3-lead electrocardiography(ECG)and pulse oximetry(POX)in neonatal heart rate(HR)monitoring after birth.Methods This prospective study recruited 42 high-risk newborns with gestational age≥37 weeks and birth weight>1500 g who were born through cesarean section without resuscitation requirement in Xi'an People's Hospital(Xi'an Fourth Hospital)from October 2019 to August 2020.3-lead ECG electrodes and POX sensors were attached to the neonates immediately after drying to continuously monitor the HR within 10 min after birth.All procedure was recorded by video camera,and data were independently analyzed by a clinician after the procedure was completed.Differences in time required to connect the devices,time to obtain a reliable HR and the interval between them,the time needed for obtaining a reliable HR after birth,the proportion of neonates with reliable HR obtained within 5 min after birth and the consistency in the reliable HR readings between the two devices were compared using Wilcoxon signed-rank test,McNemar test,Spearman's correlation coefficient,intraclass correlation coefficient or Bland-Altman bias analysis.Results The median time required to connect POX and 3-lead ECG and to acquire a reliable HR were 13.0 s(10.0-17.0 s)vs 23.0 s(18.0-28.3 s)(Z=-5.050,P<0.001),and 79.5 s(56.2-128.0 s)vs 11.0 s(10.0-13.3 s)(Z=-5.646,P<0.001),respectively.The total time from the beginning of connecting the devices and birth to acquiring a reliable HR were both longer for POX than those for 3-lead ECG[92.0 s(71.3-139.0 s)vs 35.0 s(30.0-39.5 s),Z=-5.579,P<0.001;110.5 s(85.8-153.5 s)vs 52.0 s(45.0-66.3 s),Z=-5.579,P<0.001].Reliable HRs were obtained in 69.1%(29/42)and 2.4%(1/42)of the infants by 3-lead ECG and POX within 1 min after birth,respectively.The percentage of infants for obtaining a reliable HR detected by 3-lead ECG within 5 min after birth were more than those by POX,but with statistically significant differences only at the first 60 s,90 s,120 s and 150 s(all P<0.001).The median HRs obtained by 3-lead ECG and POX within 10 min after birth were 161 beats/min(147-175 beats/min)and 160 beats/min(146-176 beats/min),respectively(r=0.966,P<0.001).The mean difference of HR detected by the two devices was 0.56 beats/min(95%CI:-4.3 to 5.4 beats/min).The intraclass correlation coefficient was 0.961,showing good internal consistency.Conclusions Neonatal HR can be assessed accurately by 3-lead ECG within 1 min after birth,which is far earlier than that by POX.Therefore,3-lead ECG can be an option for continuously HR monitor in neonatal resuscitation.