足月新生儿急性呼吸窘迫综合征动态氧合参数监测与预后的关系  

Relationship between the dynamic oxygenated parameters and prognosis in acute respiratory distress syndrome in full-term neonates

作　　者：史雪川[1] 沈青[2] 骆郁林 庄静文[1] 陈思红[1] 李伟中[1] 

机构地区：[1]汕头大学医学院第二附属医院儿科,515041 [2]第四军医大学西京医院儿科 [3]广东省汕头市第二人民医院儿科

出　　处：《中华围产医学杂志》2006年第3期172-176,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨新生儿急性呼吸窘迫综合征(acuterespiratorydistresssyndrome,ARDS)时动态氧合参数监测与预后的关系。方法三家医院41例ARDS新生儿按临床转归分为死亡组(17例)和生存组(24例),回顾性分析两组通气治疗2、12、24和36h的呼吸机参数和动脉血气值,并计算各时段的氧合指数(PaO2/FiO2)、肺泡-动脉血氧分压差(A-aDO2)、动脉血氧分压/肺泡氧分压(PaO2/PAO2)和呼吸指数(respirationindex,RI),进行组间和组内比较。结果死亡组在呼吸机参数明显或逐步高于生存组的情况下,36h的PaO2[(10.38±1.45)kPa]才低于生存组[(11.42±0.98)kPa](P<0.05)。死亡组24和36h的PaO2/FiO2[(15.86±4.92、15.99±5.62)kPa]低于生存组[(21.18±6.48、27.12±8.33)kPa](P<0.01);12、24和36h的A-aDO2[(51.33±11.51、49.36±14.09、47.96±16.70)kPa]高于生存组[(42.55±14.57、34.92±11.91、24.12±12.59)kPa](P<0.05或0.01);12、24和36h的PaO2/PAO2(0.19±0.05、0.19±0.07、0.20±0.07)低于生存组(0.23±0.08、0.27±0.09、0.36±0.12)(P<0.05或0.01);24和36h的RI(5.75±1.86、5.90±2.33)高于生存组(4.19±1.86、3.21±1.40)(P<0.01)。生存组各时段的PaO2/FiO2和PaO2/PAO2顺次增大;A-aDO2和RI顺次减小,均有显著差异(P<0.05或0.01),死亡组组内则都无变化(P>0.05)。结论在新生儿ARDS的早期,PaO2不是评估预后的有效指标,PaO2/FiO2、A-aDO2、PaO2/PAO2和RI更能反映肺损伤的程度、氧交换率和治疗效果,其中A-aDO2和PaO2/PAO2最为敏感,动态监测可帮助判断预后。Objective To investigate the clinical significance in monitoring the dynamic oxygenated parameters in full-term neonates with acute respiratory distress syndrome （ARDS） and its relationship with the prognosis. Methods Forty-one full-term neonates with ARDS from 3 hospitals were divided into two groups according to the clinical outcomes： the death group （n= 17） and the survival group （n= 24）. The parameters of breathing machine and arterial blood gas analysis in these two groups at 2 h, 12 h, 24 h and 36 h after mechanical ventilation were analyzed retrospectively. PaO2/ FiO2, A-aDO2, PaO2/PAO2 and RI were calculated and compared between the two groups and within each group among the values of different period. Results Under the circumstance that parameters of breathing machine in the death group were obviously or gradually higher than those in the survival group, PaO2 in the death group [（10.38 ± 1.45）kPa] was lower than that in the survival group [（11.42±0. 98）kPa] only at 36 h （P〈0. 05）, but no significant difference was found within each group in the value of PaO2 in different period （P〉0.05）. In the death group, PaOz/FiO2 at 24 h and 36 h [（15.86±4.92）kPa and （15.99±5.62）kPa] was lower than that in the survival group [（21.18 ±6.48）kPa and （27.12±8.33）kPa]（P〈0.01）; A-aDO2 at 12 h, 24 h and 36 h [（51.33± 11.51） kPa, 49.36± 14.09）kPa and （47.96± 16.70）kPa] was higher than that in the survival group [（42.55 ±14.57）kPa, 34. 92±11.91）kPa and （24. 12±12.59） kPa] （P〈0.05 or 0.01）; PaO2/PAO2 at 12h, 24 h and 36 h （0.19±0.05, 0.19±0.07 and 0.20±0.07） was lower than that in the survival group（0.23±0.08,0.27±0.09 and 0. 36±0.12）（P〉0.05 or 0.01）and RI at 24 h and 36 h （5.75±1.86 and 5.90±2.33）was higher （4. 19±1.86 and 3.21±1.40） （P〈0.01）. In the survival group, PaO2/FiO2 and PaO2/PAO2 were increased gradually, while A-aDO2 and RI were decreasing with significant differences were found in bet

关 键 词：呼吸窘迫综合征 新生儿 血气分析 预后 

分 类 号：R722.1[医药卫生—儿科]