PctO_2和PctCO_2在不同微循环障碍新生儿诊断中的价值及与动脉血气指标的相关性分析
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摘要
目的探讨经皮氧分压(PctO_2)和经皮二氧化碳分压(PctCO_2)在不同微循环障碍新生儿诊断中的价值,分析其与PaO_2和PaCO_2的相关性。方法选择重症新生儿96例,依据毛细血管充盈时间不同,分为微循环正常组36例、轻度微循环障碍组30例和重度微循环障碍组30例。应用经皮氧/二氧化碳分压监测仪测定所有新生儿PctO_2和PctCO_2,并同步监测PaO_2和PaCO_2。分析各组患儿PctO_2、PctCO_2的表达水平有无差异,对PctO_2和PaO_2、PctCO_2和PaCO_2进行相关性分析;采用ROC曲线分析PctO_2、PctCO_2对新生儿缺氧及CO_2潴留的早期反应性。结果微循环正常组PctO_2和PaO_2、PctCO_2和PaCO_2均呈正相关(r=0.760和0.589,均P<0.01);轻度微循环障碍组和重度微循环障碍组PctCO_2和PaCO_2均呈正相关(r=0.728和0.698,均P<0.01),但PctO_2和PaO_2均无相关性(r=0.316和0.141,均P>0.05)。3组新生儿PctO_2表达均低于PaO_2,差异均有统计学意义(均P<0.01);但PctCO_2与PaCO_2比较差异均无统计学意义(均P>0.05)。微循环正常组、轻度微循环障碍组和重度微循环障碍组PctO_2与PctCO_2诊断缺氧和CO_2潴留的AUC依次为0.88(P=0.012)和0.65(P=0.112),0.58(P=0.348)和0.91(P=0.001),0.62(P=0.152)和0.89(P=0.008)。结论微循环正常新生儿经皮监测PctO_2和PctCO_2可较好替代PaO_2和PaCO_2;轻度及重度微循环障碍新生儿PctO_2不能较好反映PaO_2,此时需结合动脉血气指标综合判断。
Objective To analyze the correlation of percutaneous oxygen pressure(PctO_2) and percutaneous carbon dioxide pressure(PctCO_2) with arterial blood gas indexes in neonatus with different microcirculation(MC) disturbance. Methods Ninety six critical neonates treated in NICU of Yongkang Maternal and Child Health Hospital from January 2016 to January 2017 were enrolled. According to the capillary refill time(CRT) patients were divided into normal MC group(n=36), mild MC disturbance group(n=30) and severe MC disturbance group(n=30). The percutaneous blood gas indexes PctO_2, PctCO_2 and the arterial blood gas indexes PaO_2, PaCO_2 were measured at the same time. The levels of PctO_2 and PctCO_2 were compared among the groups,the correlations between PctO_2 and PaO_2, between PctCO_2 and PaCO_2 were analyzed by Pearson analysis. The value of PctO_2 and PctCO_2 in assessing hypoxia and CO_2 retention was analyzed by ROC curves. Results There were positive correlations between PctO_2 and PaO_2(r=0.760, P <0.01) and between PctCO_2 and PaCO_2(r=0.589, P <0.01) in children with normal MC. In children with mild or severe MC disturbance the PctCO_2 was positively correlated with PaCO_2(r=0.728 and 0.698, both P<0.01),but PctO_2 was not correlated with PaO_2(r=0.316 and 0.141, both P >0.05). The AUC on evaluating hypoxia and CO_2 retention by PctO_2 and PctCO_2 in the normal, mild and severe MC disturbance were 0.88(P =0.012) and 0.65(P =0.112), 0.58(P=0.348) and0.91(P =0.001), 0.62(P =0.152) and 0.89(P =0.008), respectively. Conclusion The percutaneous blood gas indexes PctO_2 and PctCO_2 can better replace arterial blood gas indexes PaO_2 and PaCO_2 in neonatus with normal MC. For neonatus with mild or severe MC disturbance PaCO_2 is correlated with PaCO_2, while PctO_2 can't reflect the changes of PaO_2 and arterial blood gas analysis is necessary.
Objective To analyze the correlation of percutaneous oxygen pressure(PctO_2) and percutaneous carbon dioxide pressure(PctCO_2) with arterial blood gas indexes in neonatus with different microcirculation(MC) disturbance. Methods Ninety six critical neonates treated in NICU of Yongkang Maternal and Child Health Hospital from January 2016 to January 2017 were enrolled. According to the capillary refill time(CRT) patients were divided into normal MC group(n=36), mild MC disturbance group(n=30) and severe MC disturbance group(n=30). The percutaneous blood gas indexes PctO_2, PctCO_2 and the arterial blood gas indexes PaO_2, PaCO_2 were measured at the same time. The levels of PctO_2 and PctCO_2 were compared among the groups,the correlations between PctO_2 and PaO_2, between PctCO_2 and PaCO_2 were analyzed by Pearson analysis. The value of PctO_2 and PctCO_2 in assessing hypoxia and CO_2 retention was analyzed by ROC curves. Results There were positive correlations between PctO_2 and PaO_2(r=0.760, P <0.01) and between PctCO_2 and PaCO_2(r=0.589, P <0.01) in children with normal MC. In children with mild or severe MC disturbance the PctCO_2 was positively correlated with PaCO_2(r=0.728 and 0.698, both P<0.01),but PctO_2 was not correlated with PaO_2(r=0.316 and 0.141, both P >0.05). The AUC on evaluating hypoxia and CO_2 retention by PctO_2 and PctCO_2 in the normal, mild and severe MC disturbance were 0.88(P =0.012) and 0.65(P =0.112), 0.58(P=0.348) and0.91(P =0.001), 0.62(P =0.152) and 0.89(P =0.008), respectively. Conclusion The percutaneous blood gas indexes PctO_2 and PctCO_2 can better replace arterial blood gas indexes PaO_2 and PaCO_2 in neonatus with normal MC. For neonatus with mild or severe MC disturbance PaCO_2 is correlated with PaCO_2, while PctO_2 can't reflect the changes of PaO_2 and arterial blood gas analysis is necessary.
引文
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[2]孙文武,毛恩强.微循环变化对于脓毒症患者液体复苏治疗的意义[J].中华危重症医学杂志(电子版),2016,9(3):201-204.doi:10.3877/cma.j.issn.1674-6880.2016.03.013.
[3]He HW,Liu DW,Long Y,et al.The peripheral perfusion index and transcutaneous oxygen challenge test are predictive of mortality in septic patients after resuscitation[J].Crit Care,2013,17(3):116.doi:10.1186/cc12788.
[4]Crook J,Taylor RM.The agreement of fingertip and sternum capillary refill time in children[J].Arch Dis Child,2013,98:26.doi:10.1136/archdischild-2012-303046.
[5]肖锋.儿科急诊[J].中华急诊医学杂志,2014,23(6):718-720.doi:10.3760/cma.j.issn.1671-0282.2014.06.031.
[6]赵燕凤,张志群,芦蕙,等.脐动脉血气分析联合Apgar评分对新生儿窒息多器官损害的诊断意义[J].中华全科医学,2017,15(2):267-269.doi:10.16766/j.cnki.issn.1674-4152.2017.02.026.
[7]Benhamou Y,Begarin L,Edet S,et al.Detection of microcirculatory impairment by transcutaneous oxymetry monitoring during hemodialysis:an observational study[J].BMC Nephrology,2014,15:4.doi:10.1186/1471-2369-15-4.
[8]Yang C,Weng H,Chen L,et al.Transcutaneous oxygen pressure measurement in diabetic foot ulcers:mean values and cut-point for wound healing[J].J Wound Ostomy Continence Nurs,2013,40(6):585-589.doi:10.1097/WON.0b013e3182a9a7bf.
[9]张凤蕊,平芬,韩书芝,等.经皮无创血气监测的临床应用及研究进展[J].国际呼吸杂志,2014,34(3):231-235.doi:10.3760/cma.j.issn.1673-436X.2014.03.018.
[10]陆国平,程晔.2012版儿童严重脓毒症与脓毒性休克治疗国际指南解读[J].中国小儿急救医学,2013,20(1):4-8.doi:10.3760/cma.j.issn.1673-4912.2013.01.002.
[11]吴水晶,方向明.感染性休克救治的思考[J].中华危重症医学杂志(电子版),2014,7(5):1-4.doi:10.3877/cma.j.issn.1674-6880.2014.05.001.
[12]He HW,Liu DW,Long Y,et al.The transcutaneous oxygen challenge test:a noninvasive method for detecting low cardiac output in septic patients[J].Shock,2012,37(2):152-155.doi:10.1097/SHK.0b013e31823cc1c0.
[13]Oliver S,Michael EG,Andrea WE,et al.Transcutaneous oxygen tension monitoring in critically ill patients receiving packed red blood cells[J].Journal of Critical Care,2014,29(6):1057-1062.doi:10.1016/j.jcrc.2014.05.028.
[14]Holowaychuk MK,Fujita H,Bersenas AM,et al.Evaluation of a transcutaneous blood gas monitoring system in critically ill dogs[J].J Vet Emerg Crit Care(San Antonio),2014,24(5):545-553.doi:10.1111/vec.12216.