肺动脉压和心功能监测在新生儿肺内/肺外源性ARDS中的意义  

Significance of monitoring pulmonary arterial pressure and cardiac function in neonates with pulmonary or extra-pulmonary acute respiratory distress syndrome

作　　者：尹同进[1] 胡雨生[1] 成胜 孙斌[2] Yin Tongjin;Hu Yusheng;Cheng Sheng;Sun Bin(Department of Neonatology,the Affiliated Yancheng Hospital of Southeast University Medical College(Yancheng Third People's Hospital,the Sixth Affiliated Hospital of Nantong University),Yancheng 224001,Jiangsu,China;Department of Neonatology,Children's Hospital of Soochow University,Suzhou 215003,Jiangsu,China)

机构地区：[1]东南大学医学院附属盐城医院(盐城市第三人民医院,南通大学第六附属医院)新生儿科,江苏盐城224001 [2]苏州大学附属儿童医院新生儿科,江苏苏州215003

出　　处：《中华危重病急救医学》2021年第7期838-843,共6页Chinese Critical Care Medicine

基　　金：江苏省重点研发专项(BE2015644);江苏省盐城市医学科技发展计划项目(YK2016069,YK2018133)。

摘　　要：目的探讨肺内/肺外源性急性呼吸窘迫综合征(ARDSp/ARDSexp)新生儿在围生期肺动脉压(PAP)和心功能指标的变化及意义。方法采用观察性研究方法,选择东南大学医学院附属盐城医院新生儿科2016年1月至2020年12月收治的急性呼吸窘迫综合征(ARDS)新生儿128例,其中ARDSp 67例,ARDSexp 61例。比较两组新生儿机械通气上机后氧合指数〔OI,OI=平均气道压(Pmean)×吸入氧浓度(FiO_(2))/动脉血氧分压(PaO_(2))×100〕、PAP、心功能指标〔心排血指数(CI)、左室射血分数(LVEF)、右心室做功指数(RV-Tei)〕和血浆N末端脑钠肽前体(NT-proBNP)的差异;记录新生儿肺动脉高压〔PAH,肺动脉收缩压(PASP)>35 mmHg(1 mmHg=0.133 kPa)或超过体循环收缩压的2/3〕的发生率;采用Pearson相关法分析PAP与NT-proBNP的相关性;同时动态观察ARDSp与ARDSexp合并中重度PAH(PASP 50~69 mmHg为中度,PASP≥70 mmHg为重度)新生儿应用强心药米力农治疗前后PAP和RV-Tei的变化。记录两组新生儿的机械通气时间、总住院时间和预后;绘制Kaplan-Meier生存曲线,分析两组新生儿28 d累积生存情况。结果ARDSp组新生儿PAH的发生率明显高于ARDSexp组(97.01%比70.49%,P<0.01),OI、PAP、NT-proBNP和RV-Tei均明显高于ARDSexp组〔OI:17.61±6.12比11.04±5.35,PAP(mmHg):64.27±9.54比53.61±6.47,NT-proBNP(ng/L):23126.32±1485.14比18624.24±1647.15,RV-Tei:0.61±0.22比0.52±0.19,均P<0.05〕;两组CI和LVEF比较差异无统计学意义。Pearson相关性分析显示,PAP与NT-proBNP呈明显正相关(r=0.918,P<0.01)。共有97例ARDS合并中重度PAH新生儿,其中ARDSp组63例,ARDSexp组34例;随米力农治疗时间延长,两组PAP和RV-Tei整体均呈下降趋势,ARDSexp组较ARDSp组下降更为显著,治疗72 h时差异有统计学意义〔PAP(mmHg):38.42±8.95比45.67±13.32,RV-Tei:0.58±0.19比0.61±0.13,均P<0.05〕;两组拔管前PAP和RV-Tei差异无统计学意义。ARDSp组机械通气时间和总住院时间较ARDSexp组明显延长�Objective To evaluate the dynamic changes of pulmonary arterial pressure(PAP)and cardiac function in neonates with pulmonary or extra-pulmonary acute respiratory distress syndrome(ARDSp/ARDSexp).Methods An observational study was conducted.A total of 128 neonates with ARDS admitted to neonatology department of the Affiliated Yancheng Hospital of Southeast University Medical College from January 2016 to December 2020 were enrolled,with 67 neonates in ARDSp group and 61 neonates in ARDSexp group.After starting mechanical ventilation,oxygenation index[OI,OI=mean airway pressure(Pmean)×fraction of inspired oxygen(FiO_(2))/arterial partial pressure of oxygen(PaO_(2))×100],PAP,cardiac function parameters[cardiac index(CI),left ventricular ejection fraction(LVEF),right ventricular Tei(RV-Tei)],and plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)were compared between the two groups;the incidence of pulmonary arterial hypertension[PAH,pulmonary artery systolic pressure(PASP)was more than 35 mmHg(1 mmHg=0.133 kPa)or more than 2/3 of the systolic blood pressure of the body circulation]of neonates was recorded.The correlation between PAP and NT-proBNP was analyzed by Pearson correlation method.The dynamically changes in PAP and RV-Tei before and after using Milrinone in neonates with ARDSp and ARDSexp combined with moderate-severe PAH(PASP 50-69 mmHg was moderate,and PASP≥70 mmHg was severe)were observed.The duration of mechanical ventilation,total length of hospital stay and prognosis were recorded;Kaplan-Meier survival curve was drawn to analyze the 28-day survival of the two groups.Results The occurrence rate of PAH in ARDSp group was significantly higher than that in ARDSexp group(97.01%vs.70.49%,P<0.01).OI,PAP,NT-proBNP and RV-Tei were also higher[OI:17.61±6.12 vs.11.04±5.35,PAP(mmHg):64.27±9.54 vs.53.61±6.47,NT-proBNP(ng/L):23126.32±1485.14 vs.18624.24±1647.15,RV-Tei:0.61±0.22 vs.0.52±0.19,all P<0.05],but there was no significant difference in CI or LVEF between the two groups.Pearson correlation

关 键 词：急性呼吸窘迫综合征 肺动脉压 心功能 新生儿 

分 类 号：R722.1[医药卫生—儿科]