灌注指数以及灌注变异指数在早产儿动脉导管未闭中的应用
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摘要
目的:探讨灌注指数(PI)、灌注变异指数(PVI)在判断动脉导管未闭(PDA)是否需要使用药物以及使用药物后关闭动脉导管情况的价值,从而指导临床治疗PDA。方法:选取2015年4-12月入住本院NICU的早产儿129例,根据出生后3 d内超声检查结果将其分为PDA组(n=78)和正常早产儿组(n=51),再根据动脉导管封管的临床需要,将PDA组分为治疗组(n=47)、未治疗组(n=31)。比较三组PI和PVI,治疗组动脉导管闭合前后PI和PVI。结果:治疗组PI均低于未治疗组和正常早产儿组,PVI均高于未治疗组和正常早产儿组,差异均有统计学意义(P<0.05),且未治疗组PVI高于未治疗组(P<0.05),但未治疗组和正常早产儿组PI比较,差异统计学意义(P>0.05);动脉导管闭合后,治疗组PI高于闭合前,PVI低于闭合前,差异均有统计学意义(P<0.05)。结论:动脉导管被药物封闭后,PI、PVI数据趋于正常早产儿,对该指标进行监测具有临床价值。
Objective:To explore the value of perfusion index(PI)and perfusion variation index(PVI in judging whether patent ductus arteriosus(PDA)needs drugs and closing the ductus arteriosus after using drugs,so as to guide clinical treatment of PDA.Method:A total of 129 cases of premature infants admitted to NICU from April to December 2015 were selected.According to the results of ultrasound examination within 3 days after birth,they were divided into PDA group(n=78)and normal preterm infant group(n=51),according to the clinical needs of arterial duct occlusion,PDA group was divided into treatment group(n=47)and non-treatment group(n=31).PI and PVI among the three groups were compared,and PI and PVI before and after closure of arterial catheter in treatment group were observed.Result:The PI of treatment group were lower than those of nontreatment group and the normal preterm group,and the PVI were higher than those of non-treatment group and the normal preterm group,the differences were statistically significant(P<0.05),and the PVI of non-treatment group was higher than that of normal preterm group(P<0.05),but the PI in on-treatment group and the normal preterm group was compared,the difference was not statistically significant(P>0.05).After closure of the ductus arteriosus,PI in treatment group was higher than that of before closure,and PVI was lower than that of before closure,the differences were statistically significant(P<0.05).Conclusion:The PI of PDA infants is lower than that of normal preterm infants,and the PVI is higher than that of normal preterm infants,after the arterial catheter is blocked by drugs,the PI and PVI data tend to be normal preterm infants,monitoring this index has clinical value.
Objective:To explore the value of perfusion index(PI)and perfusion variation index(PVI in judging whether patent ductus arteriosus(PDA)needs drugs and closing the ductus arteriosus after using drugs,so as to guide clinical treatment of PDA.Method:A total of 129 cases of premature infants admitted to NICU from April to December 2015 were selected.According to the results of ultrasound examination within 3 days after birth,they were divided into PDA group(n=78)and normal preterm infant group(n=51),according to the clinical needs of arterial duct occlusion,PDA group was divided into treatment group(n=47)and non-treatment group(n=31).PI and PVI among the three groups were compared,and PI and PVI before and after closure of arterial catheter in treatment group were observed.Result:The PI of treatment group were lower than those of nontreatment group and the normal preterm group,and the PVI were higher than those of non-treatment group and the normal preterm group,the differences were statistically significant(P<0.05),and the PVI of non-treatment group was higher than that of normal preterm group(P<0.05),but the PI in on-treatment group and the normal preterm group was compared,the difference was not statistically significant(P>0.05).After closure of the ductus arteriosus,PI in treatment group was higher than that of before closure,and PVI was lower than that of before closure,the differences were statistically significant(P<0.05).Conclusion:The PI of PDA infants is lower than that of normal preterm infants,and the PVI is higher than that of normal preterm infants,after the arterial catheter is blocked by drugs,the PI and PVI data tend to be normal preterm infants,monitoring this index has clinical value.
引文
[1]杨波,佟念念,高翔羽,等.早产儿动脉导管未闭治疗前后3项心脏指标的变化[J].中华实用儿科临床杂志,2016,31(3):212-216.
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[4]卢凯珊,郭小玲,吕峻峰,等.氨基末端脑钠肽前体预测早产儿症状性动脉导管未闭的价值[J].中国当代儿科杂志,2015,17(11):1160-1164.
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[7]陆丹芳,刘云峰,童笑梅.早产儿动脉导管未闭的临床特点及其心脏血流动力学研究[J].中华儿科杂志,2015,53(3):187-193.
[8]李洁,张可刚,孙波,等.不同胎龄早产儿PDA发病率的临床研究[J].中国现代医生,2017,55(3):43-44.
[9]田方,石文静.胎龄<28周早产儿动脉导管未闭的治疗进展[J].中国当代儿科杂志,2015,17(10):1142-1146.
[10]时赞扬,张茜.B型利钠肽及氨基末端脑钠肽前体水平与早产儿疾病相关性研究进展[J/OL].中华临床医师杂志(电子版),2013,7(8):3490-3493.
[11]陈佳,李秋平,张幸,等.早产儿动脉导管未闭高危因素分析[J].中国新生儿科杂志,2012,27(6):377-381.
[12]李秋平,封志纯.早产儿动脉导管未闭管理中的困惑与思考[J].中华儿科杂志,2016,54(1):3.
[13]Sallmon H,Weber S C,Hüning B,et al.Thrombocytopenia in the first 24 hours after birth and incidence of patent ductus arteriosus[J].Pediatrics,2012,130(3):623-630.
[14]Sivanandan S,Agarwal R.Pharmacological closure of patent ductus arteriosus:selecting the agent and route of administration[J].Paediatr Drugs,2016,18(2):123-138.
[15]Sellmer A,Hjortdal V E,Bjerre J V,et al.N-terminal pro-Btype natriuretic peptide as a marker of bronchopulmonary dysplasia or death in very preterm neonates:a cohort study[J].PLoS One,2015,10(10):e0140079.
[16]韦秋菊.布洛芬治疗早产儿动脉导管未闭效果及影响因素[J].中国保健营养旬刊,2014,24(2):1015-1016.
[17]康静.布洛芬与对乙酰氨基酚治疗早产儿症状性动脉导管未闭对前列腺素E2的影响[J].中南药学,2016,11(2):197-202.
[18]容跃,杨正春,冉素真,等.超声心动图血流参数预测早产儿动脉导管早期自然关闭的价值[J].重庆医学,2015,44(36):5098-5100.
[2]Du J F,Liu T T,Wu H.Case-control study on risk factors of patent ductus arteriosus in early preterm infants[J].Zhongguo Dang Dai Er Ke Za Zhi,2016,18(1):15-19.
[3]张立平,丁盛,杨永健,等.动脉导管未闭封堵术后血小板减少原因分析及其防治[J].临床心血管病杂志,2013,29(2):129-131.
[4]卢凯珊,郭小玲,吕峻峰,等.氨基末端脑钠肽前体预测早产儿症状性动脉导管未闭的价值[J].中国当代儿科杂志,2015,17(11):1160-1164.
[5]Terrin G,Conte F,Oncel M Y,et al.Paracetamol for the treatment of patent ductus arteriosus in preterm neonates:a systematic review and meta-analysis[J].Arch Dis Child Fetal Neonatal Ed,2016,101(2):F127-136.
[6]赵金章,李明霞.早产儿动脉导管未闭发病机制研究进展[J].中华实用儿科临床杂志,2014,29(1):60-63.
[7]陆丹芳,刘云峰,童笑梅.早产儿动脉导管未闭的临床特点及其心脏血流动力学研究[J].中华儿科杂志,2015,53(3):187-193.
[8]李洁,张可刚,孙波,等.不同胎龄早产儿PDA发病率的临床研究[J].中国现代医生,2017,55(3):43-44.
[9]田方,石文静.胎龄<28周早产儿动脉导管未闭的治疗进展[J].中国当代儿科杂志,2015,17(10):1142-1146.
[10]时赞扬,张茜.B型利钠肽及氨基末端脑钠肽前体水平与早产儿疾病相关性研究进展[J/OL].中华临床医师杂志(电子版),2013,7(8):3490-3493.
[11]陈佳,李秋平,张幸,等.早产儿动脉导管未闭高危因素分析[J].中国新生儿科杂志,2012,27(6):377-381.
[12]李秋平,封志纯.早产儿动脉导管未闭管理中的困惑与思考[J].中华儿科杂志,2016,54(1):3.
[13]Sallmon H,Weber S C,Hüning B,et al.Thrombocytopenia in the first 24 hours after birth and incidence of patent ductus arteriosus[J].Pediatrics,2012,130(3):623-630.
[14]Sivanandan S,Agarwal R.Pharmacological closure of patent ductus arteriosus:selecting the agent and route of administration[J].Paediatr Drugs,2016,18(2):123-138.
[15]Sellmer A,Hjortdal V E,Bjerre J V,et al.N-terminal pro-Btype natriuretic peptide as a marker of bronchopulmonary dysplasia or death in very preterm neonates:a cohort study[J].PLoS One,2015,10(10):e0140079.
[16]韦秋菊.布洛芬治疗早产儿动脉导管未闭效果及影响因素[J].中国保健营养旬刊,2014,24(2):1015-1016.
[17]康静.布洛芬与对乙酰氨基酚治疗早产儿症状性动脉导管未闭对前列腺素E2的影响[J].中南药学,2016,11(2):197-202.
[18]容跃,杨正春,冉素真,等.超声心动图血流参数预测早产儿动脉导管早期自然关闭的价值[J].重庆医学,2015,44(36):5098-5100.