右心功能监测对新生儿急性呼吸窘迫综合征预后的评估价值

The Value of Right Heart Function Monitoring in Assessing the Prognosis of Acute Respiratory Distress Syndrome in Neonates

目的探讨右心功能监测对新生儿急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)预后的评估价值。方法选取112例ARDS新生儿,均行常规机械通气和基础药物治疗,根据28 d预后情况将其分为预后良好组和预后不良组,采用全自动生化分析仪检测新生儿血常规及钙素原(procalcitonin,PCT)、C-反应蛋白(C-reactive protein,CRP)、血浆N末端脑钠肽前体(N-terminal brain natriuretic peptide precursor,NT-proBNP)水平;采用超声心动图检测新生儿心功能指标[心脏指数(cardiac index,CI)、右心室做功指数(right ventricular work index,RV-Tei)、右心室射血分数(right ventricular ejection fraction,RVEF)];收集新生儿临床资料,logistic多因素回归分析法明确影响新生儿ARDS预后的危险因素,绘制受试者操作特征(ROC)曲线评估右心功能监测对新生儿ARDS预后的预测价值。结果112例ARDS新生儿中81例预后良好,31例预后不良。预后良好组胎龄、住院时间氧合指数(OI)、球蛋白、白蛋白、PCT含量高于预后不良组,PS使用次数≥3的比例及机械通气时间、CRP、RV-Tei、NT-proBNP、RVEF低于预后不良组,差异有统计学意义(P<0.05)。logistic多因素回归分析结果显示,RV-Tei(P=0.011、OR=3.836、95%CI:1.363~10.797)、NT-proBNP(P=0.001、OR=2.322、95%CI:1.411~3.820)是影响新生儿ARDS预后的独立危险因素。经ROC曲线分析,RV-Tei联合NT-proBNP对新生儿ARDS预后的敏感度、准确度、曲线下面积(AUC)分别为92.60%、91.54%、0.822。结论RV-Tei、NT-proBNP与新生儿ARDS预后相关,二者联合评估ARDS新生儿的预后价值较高。

Objective Objective To investigate the value of right heart function monitoring in assessing the prognosis of acute respiratory distress syndrome(ARDS)in neonates.Methods All 112 neonates with ARDS were selected to be treated with conventional mechanical ventilation and basic medication,and were categorized into good prognosis and poor prognosis groups according to their 28-day prognosis.A fully automatic biochemical analyzer was used to detect neonatal blood and procalcitonin(PCT),C-reactive protein(CRP),and plasma N-terminal brain natriuretic peptide precursor(NT-proBNP)levels.Neonatal cardiac function indices[cardiac index(CI),right ventricular work index(RV-Tei)and right ventricular ejection fraction(RVEF)]were detected using echocardiography.Clinical data of neonates were collected,logistic multifactorial regression analysis was used to clarify the risk factors affecting the prognosis of neonatal ARDS,and the predictive value of right heart function monitoring on the prognosis of neonatal ARDS was assessed by plotting the subject operating characteristic(ROC)curve.Results Of the 112 neonates with ARDS,81 had a favorable prognosis and 31 had a poor prognosis.Gestational age,length of hospitalization,oxygenation index(OI),and globulin,albumin,and PCT levels were higher in the good prognosis group than those in the poor prognosis group(P<0.05).However,the proportion of PS use≥3,the duration of mechanical ventilation,CRP,RV-Tei,NT-proBNP and RVEF were lower than those in the poor prognosis group(P<0.05).The results of logistic multifactorial regression analysis showed that RV-Tei(P=0.011,OR=3.836,95%CI:1.363-10.797)and NT-proBNP(P=0.001,OR=2.322,95%CI:1.411-3.820)were the independent risk factors affecting the prognosis of neonatal ARDS.After ROC curve analysis,the sensitivity,accuracy and area under the curve(AUC)of RV-Tei combined with NT-proBNP for prognosis of neonatal ARDS were 92.60%,91.54%and 0.822,respectively.Conclusion RV-Tei and NT-proBNP are associated with the prognosis of neonatal ARDS,and the prognostic value of the two combined evaluation of ARDS neonates is high.