脉搏血氧灌注指数与血乳酸浓度对早产儿视网膜病变的早期预测价值

The predictive value of pulse oxygen perfusion index and blood lactic acid concentration for early retinopathy of prematurity

目的探讨脉搏血氧灌注指数(PI)与血乳酸浓度对早产儿视网膜病变(ROP)的早期预测价值。方法选取2018年9月至2022年12月我院新生儿重症监护病房收治的符合纳入标准的早产儿128例作为研究对象,进行回顾性病例对照研究。其中46例患有ROP的患儿为ROP组,另外82例未患ROP者为非ROP组。入院后记录早产儿基本资料,采用Masimo Radical-7(USA)SpO_(2)血氧饱和度检测仪连续监测早产儿PI,采用ABL90FLEX血气分析仪监测早产儿血乳酸浓度。采用受试者工作特征曲线及曲线下面积(AUC)评价PI及血乳酸浓度对ROP的早期预测价值。结果两组早产儿胎龄、出生体重、性别、分娩方式差异均无统计学意义(均为P>0.05)。两组早产儿出生后PI差异有统计学意义(F_(组间)=15.393,P_(组间)<0.001);ROP组早产儿出生后1 h、12 h、24 h PI较非ROP组明显下降,出生后48 h至96 h轻度下降,两组早产儿PI于出生后96 h后趋于平稳;ROP组早产儿出生后96 h内各时间点PI均低于非ROP组早产儿(均为P<0.05);两组不同时间与组别间存在交互效应(F_(交互)=5.061,P_(交互)<0.001)。两组早产儿出生后血乳酸浓度比较差异有统计学意义(F_(组间)=91.158,P_(组间)<0.001);ROP组早产儿出生后1 h血乳酸浓度较非ROP组明显上升,出生后12 h、24 h血乳酸浓度较非ROP组轻度升高;ROP组早产儿出生后各时间点血乳酸浓度均高于非ROP组(均为P<0.05);两组不同时间与组别间不存在交互效应(F_(交互)=0.567,P_(交互)>0.05)。早产儿出生后1 h、12 h、24 h的PI及出生后1 h血乳酸浓度预测ROP的AUC分别为0.77、0.82、0.83、0.82,出生后1 h、12 h、24 h的PI及出生后1 h血乳酸浓度联合预测ROP的AUC为0.94,高于单一指标的预测价值。结论PI及血乳酸浓度对ROP有较好的早期预测价值。

Objective To investigate the value of pulse oxygen perfusion index(PI)and blood lactic acid(BLA)concentration in early prediction of retinopathy of prematurity(ROP).Methods A retrospective case-control study was conducted on 128 preterm infants who met the inclusion criteria and were admitted to the neonatal intensive care unit of our hospital from September 2018 to December 2022.Among them,46 patients with ROP were in the ROP group,and 82 patients without ROP were in the non-ROP group.Basic data of these preterm infants were recorded after admission.PI values were continuously monitored with the Masimo Radical-7(USA)SpO_(2) blood oxygen saturation detector,and BLA concentrations were detected with the ABL90FLEX blood gas analyzer.The receiver operating characteristic(ROC)curve and area under curve(AUC)were used to evaluate the value of PI and BLA concentration in early prediction of ROP.Results There were no significant differences in gestational age,birth weight,sex,and delivery mode between the two groups(all P>0.05).The PI values after birth were significantly different between the two groups(F_(group)=15.393,P_(group)<0.001).The PI values of preterm infants in the ROP group decreased significantly at 1 h,12 h and 24 h after birth and slightly at 48 h to 96 h after birth compared with the non-ROP group.The PI values of preterm infants in the two groups stabilized at 96 h after birth.The PI values of preterm infants in the ROP group were lower than those in the non-ROP group at all time points within 96 h after birth(all P<0.05).The PI values showed interaction effects between the two groups at different time points(F_(interaction)=5.061,P_(interaction)<0.001).There was a significant difference in BLA concentration between the two groups after birth(F_(group)=91.158,P_(group)<0.001).In the ROP group,the BLA concentration increased significantly at 1 h after birth and slightly at 12 h and 24 h after birth compared with the non-ROP group.The BLA concentration in the ROP group was higher than that in the non-ROP group at all time points after birth(all P<0.05).The BLA concentration showed no interaction effects between the two groups at different time points(F_(interaction)=0.567,P_(interaction)>0.05).The AUC of PI values at 1 h,12 h and 24 h after birth and BLA concentration at 1 h after birth for predicting ROP was 0.77,0.82,0.83,and 0.82,respectively.The AUC of combined PI values at 1 h,12 h and 24 h after birth and BLA concentration at 1 h after birth for predicting ROP was 0.94,higher than the predictive value of a single indicator.Conclusion PI and BLA concentration have good clinical value for early prediction of ROP.