经皮脉搏氧饱和度测定结合复苏囊筛查新生儿复杂性先天性心脏病  

Peripheral oxygen saturation under spontaneous respirations and self-inflating bag in screening of complex congenital heart disease in newborns

作　　者：陈冶[1] 洪淑君 张艳丽[1] 潘家华[1] 陈名武[1] 

机构地区：[1]安徽医科大学附属省立医院儿科,合肥230001

出　　处：《中国新生儿科杂志》2015年第4期246-250,共5页Chinese Journal of Neonatology

基　　金：安徽省自然科学基金项目(1208085MH160);安徽省教育厅基金项目(KJ2011Z171)

摘　　要：目的探讨经皮脉搏氧饱和度(SpO2)监测结合新生儿复苏囊在早期筛查新生儿复杂性先天性心脏病(CCHD)中的临床应用价值。方法选择2013年1月至2014年9月在我院分娩后即入住我科的新生儿,入院后监测并记录生后24 h的SpO2(SpO2-Ⅰ),同时完善胸部X线片检查以排除存在肺炎、气胸、新生儿呼吸窘迫综合征、胎粪吸入综合征、重度湿肺等的患儿。选择SpO2-Ⅰ≤85%的患儿予以新生儿复苏囊接空气源进行通气30 s后并记录SpO2值(SpO2-Ⅱ),根据SpO2-Ⅱ结果将患儿分为下降组(SpO2-Ⅱ较SpO2-Ⅰ下降的患儿)和上升组(SpO2-Ⅱ较SpO2-Ⅰ上升的患儿)。上升组患儿予以新生儿复苏囊接氧气源(流量2L/min,氧浓度30%)进行通气30 s后再次记录SpO2值(SpO2-Ⅲ)。所有入选新生儿住院期间同时行心脏彩超检查以明确是否存在先天性心脏病及其类型。选取同期入院心脏彩超结果正常、SpO2≤85%的肺炎患儿为对照组,用同样方法测量并记录对照组患儿的SpO2-Ⅰ、SpO2-Ⅱ和SpO2-Ⅲ。比较分析三组患儿SpO2-Ⅰ、SpO2-Ⅱ和SpO2-Ⅲ值;对上升组和下降组患儿的CCHD类型、例数和SpO2结果进行分类比较。结果上升组(39例)和下降组(30例)SpO2-Ⅰ、SpO2-Ⅱ及SpO2-Ⅰ与SpO2-Ⅱ差值均低于对照组,差异有统计学意义(P<0.01),上升组和下降组差异无统计学意义(P>0.05);上升组SpO2-Ⅲ低于对照组,差异有统计学意义(P<0.01)。下降组心脏彩超均提示为CCHD,其SpO2下降幅度约7.8%;上升组33例心脏彩超提示为CCHD,5例为单纯性先天性心脏病,1例正常,33例CCHD患儿SpO2上升幅度约8.1%。结论 SpO2监测结合新生儿复苏囊对于新生儿CCHD筛查具有较高的临床应用价值,是一项安全、非侵入性、可行且合理的检测技术,在无法实行床边心脏彩超检查时可初步筛查新生儿临床疑诊的CCHD。Objective To evaluate the clinical effects of peripheral oxygen saturation（ SpO2）under spontaneous respirations and self-inflating bag in early screening of complex congenital heart disease（ CCHD） in newborns. Methods Inclusion criteria for test group： 1. Newborns who were born in the Hospital from Jan 2013 to Sep 2014 and admitted to our Department. 2. SpO2 immediately after admission（ SpO2-Ⅰ） were no more than 85%. 3. Pneumonia,pneumothorax,respiratory distress syndrome（ RDS）,meconium aspiration syndrome（ MAS） and severe wet lung etc. were ruled out by chest radiography. Positive pressure ventilation（ PPV） via bag mask in room air were administered to the enrolled newborns for 30 seconds. The SpO2 afterwards were recorded as SpO2-Ⅱ. According to the relationship between SpO2-Ⅰ and SpO2-Ⅱ,the newborns were assigned into two subgroups： the increasing group（ the SpO2-Ⅱ was higher than SpO2-Ⅰ） and the decreasing group（ the SpO2-Ⅱ was lower than SpO2-Ⅰ）. In increasing group,PPV via bag mask with oxygen were provided for 30 seconds.The SpO2 afterwards were recorded as SpO2-Ⅲ. The echocardiography of each enrolled newborn was completed during hospitalization to confirm the existence and type of congenital heart disease. Newborns born and admitted to our department during the same time period whose SpO2-Ⅰ ≤85% with normal echocardiography and diagnosed as pneumonia by chest radiography were selected as control group.SpO2-Ⅰ,SpO2-Ⅱ and SpO2-Ⅲ were measured in control group with the same method. SpO2-Ⅰ,SpO2-Ⅱ and SpO2-Ⅲ were compared among increasing group,decreasing group and control group by SPSS 17. 0. Results There were no statistical significant differences in sex,gestational age and birth weight among the three groups（ P〉 0. 05）. The difference of SpO2-Ⅱ between decreasing group and control group was statistically significant（ P〈 0. 01）. The difference of SpO2-Ⅱ and SpO2-Ⅲ between increasing group and control group was statistica

关 键 词：心脏病 先天性 复杂性 经皮氧饱和度 复苏囊 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]