氧指数和碱剩余对非ECMO治疗新生儿急性呼吸窘迫综合征预后的预测价值

The predictive value of oxygen index and alkaline excess in non-external membrane oxygenation treatment of neonatal acute respiratory distress syndrome prognosis

目的:分析氧指数(OI)和碱剩余(BE)对非体外膜氧合(ECMO)治疗新生儿急性呼吸窘迫综合征(ARDS)预后的预测价值。方法:选取2016年7月-2021年7月收治的非ECMO治疗的ARDS新生儿为研究对象,记录患儿的人口学及临床检验指标,根据患儿出院前是否死亡分为存活组和死亡组。采用多因素logistic回归统计非ECMO治疗的ARDS患儿各指标与其病死率的相关性,分析各影响因素对病死率的预测价值。结果:共纳入103例患儿,存活组患儿77例,死亡组患儿26例,2组在性别、分娩方式、OI、血液酸碱度(PH)、BE方面比较差异有统计学意义(P<0.05)。受试者工作特征曲线(ROC)分析表明,OI和BE结合在预测患儿预后的能力上优于其他变量。OI和BE结合预测患儿预后的曲线下面积(AUC)为0.865。当OI>30 mmHg和BE<-7.40 mmol/L时,预测患儿死亡的灵敏度和特异度分别为77.0%和84.0%。结论:OI和BE相结合可作为非ECMO治疗的ARDS新生儿病死率的预测指标,OI>30 mmHg和BE<-7.40 mmol/L可作为选择ECMO治疗的重要依据之一。

Objective:Toanalyze the predictivevalueof oxygen index(O I)and alkalineexcess(BE)onthe prognosis of non-external membrane oxygenation(EC M O)in the treatm ent of neonatal acute respiratory distress syndrome(ARDS).M ethods:Theneonateswith A RD S who were not treated with EC M O inour hospital from Ju-ly 2016 to July 2021 were selected.The demographic and clinical test indicators of the neonates were recorded.The neonates were divided into two groups according to whether theywere survival at discharge.Multivariate logistic regression wasused to analyze the correlation between theclinical indicatorsof non-ECMO-treated ARDS neonates and their mortality and to analyze the predictive value of each influence factor on mortality.Results:Atotalof 103 neonates were included,77 neonates survived at discharge and 26 children died.Therewere statistically sig-nificant differences between the two groups in termsof gender,delivery m ethod,O I,PH,and BE(P<0.05)Receiver operating characteristic curve(ROC)analysis shows that the com bination of OI and BE is superior to other variables in predictive ability.The area under the combined curve of OI and BE(AUC)is 0.865.When OI>30mmHg and BE<-7.40mmol/L,the sensitivity and specificity of predicting death were 77.0%and 84.0%,respectively.Conclusion:The combination of OI and BE can be used as a predictor of non-ECMO treat-ment of neonatal ARDSmortality.OI>30mmHg and BE<-7.40mmol/L can be considered as one of the important evidences for the selection of ECMO treatment.