POC-LUS联合氧合指数在MAS新生儿机械通气撤机时机中的预测价值

Predictive value of POC-LUS combined with oxygenation index in the timing of weaning from mechanical ventilation in MAS newborns

目的探讨床旁即时肺超声评分(POC-LUS)联合氧合指数在预测胎粪吸入综合征(MAS)新生儿撤机时机中的临床价值。方法选取2022年1月—2023年12月在江苏省苏北人民医院新生儿重症监护病房行机械通气治疗的MAS患儿59例。根据撤机结局,将上述患儿分为撤机成功组和撤机失败组。收集患儿基本资料,包括性别、胎龄、出生体重、Apgar评分,撤机前6 h内的心率(HR)、呼吸频率(RR)、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、pH值、吸入氧气分数(FiO_(2))。比较2组POC-LUS评分及氧合指数,并进行相关性分析。绘制受试者工作特征(ROC)曲线,预测POC-LUS评分、氧合指数和二者联合检测在预测MAS患儿撤机时机中的效能。结果59例患儿中撤机成功组45例,失败组14例。成功组RR和POC-LUS评分显著低于失败组,氧合指数明显高于失败组,差异均有统计学意义(P<0.05)。相关性分析显示,POC-LUS评分与氧合指数呈显著负相关(r=-0.979,P<0.05)。ROC曲线分析显示,当POC-LUS评分<38.5分时,预测撤机成功的曲线下面积(AUC)达到0.893,敏感度为0.898,特异度为0.786,效能优于氧合指数。POC-LUS评分与氧合指数联合评估预测MAS患儿撤机成功中的效能更高,AUC为0.921,敏感度0.956,特异度为0.714。结论LUS-POC评分与氧合指数联合使用能够有效辅助预测MAS患儿能否撤机成功,可以作为一种判定撤机时机的有效手段,具有较高的临床推广价值。

Objective To explore the clinical value of point of care lung ultrasound scoring(POC-LUS)combined with oxygenation index in predicting the timing of weaning from mechanical ventilation in newborns with meconium aspiration syndrome(MAS).Methods A total of 59 MAS child patients who underwent mechanical ventilation in the neonatal intensive care unit of Northern Jiangsu People′s Hospital from January 2022 to December 2023 were selected.According to the weaning outcomes,the patients were divided into two groups:a successful weaning group and a failed weaning group.Their general information was collected,including gender,gestational age,birth weight,and Apgar score;heart rate(HR),respiratory rate(RR),arterial oxygen partial pressure(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2)),pH value,and fraction of inspired oxygen(FiO_(2))were recorded within 6 h before weaning.Both groups were compared for POC-LUS scores and oxygenation index,and correlation analysis was performed.ROC curves were plotted to predict the efficiency of POC-LUS scores and oxygenation index alone or their combination in predicting the timing of weaning in MAS patients.Results Among the 59 patients,45 were in the successful weaning group and 14 in the failed group.The successful group showed significantly lower RR and POC-LUS scores than the failed group,while the oxygenation index was significantly higher(P<0.05).Correlation analysis indicated that POC-LUS scores were significantly negatively related with oxygenation index(r=-0.979,P<0.05).ROC curve analysis demonstrated that when the POC-LUS score was<38.5,the area under the curve(AUC)for predicting successful weaning reached 0.893,with a sensitivity of 0.898 and specificity of 0.786,suggesting superior efficiency to oxygenation index alone.The combination of POC-LUS scores and oxygenation index showed even higher predictive efficiency for successful weaning in MAS infants,with an AUC of 0.921,a sensitivity of 0.956,and a specificity of 0.741.Conclusions The combined use of POC-LUS scores and oxygenation index can effectively assist in predicting the success of weaning from mechanical ventilation in MAS patients,serving as an effective method for determining the timing of weaning,with high clinical promotional value.