胸腔生物电阻抗法无创血流动力学监测对新生儿脓毒症患儿心功能障碍的预测价值  

Predictive value of non-invasive hemodynamic monitoring by bioelectrical impedance analysis in neonatal sepsis complicated with cardiac dysfunction

作　　者：张慧平 王金会 李思袖 杨雪峰 唐小晶 张海波[1] 朱巧棉 梁若冰 孙欢[1] 简茹 刘建萍 Zhang Huiping;Wang Jinhui;Li Sixiu;Yang Xuefeng;Tang Xiaojing;Zhang Haibo;Zhu Qiaomian;Liang Ruobing;Sun Huan;Jian Ru;Liu Jianping(Neonatal Intensive Care Unit,Affiliated Children′s Hospital of Xi′an Jiaotong University,Xi′an 710003,Shaanxi Province,China)

机构地区：[1]西安交通大学附属儿童医院新生儿重症监护室,710003

出　　处：《中华妇幼临床医学杂志（电子版）》2022年第2期220-227,共8页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：陕西省科技厅自然科学基础研究计划面上项目(2020JM-651);西安交通大学附属儿童医院院级项目(2019A01、2017A09)。

摘　　要：目的探讨胸腔生物电阻抗法无创血流动力学监测(NHM-BIA)预测新生儿脓毒症(NS)患儿心功能障碍(CD)的价值。方法选择2017年1月至2020年11月,西安交通大学附属儿童医院新生儿重症监护病房(NICU)收治的152例NS患儿为研究对象。采用回顾性研究方法,根据NS患儿是否并发CD,将其分为研究组(n=53,并发CD)与对照组(n=99,未并发CD)。对2组患儿性别、出生胎龄、出生体重、危重新生儿比例,血清N-末端脑利钠肽前体(NT-proBNP)、高敏肌钙蛋白(hs-cTn),肌酸激酶同工酶MB(CK-MB),心房、室内径及射血分数,以及心率、每搏输出量指数(SI)、心排血量(CO)、心指数、每搏输出量变异度(SVV)、校正流动时间(FTC)、外周血管阻力(SVR)、外周血管阻力指数(SVRI)、心肌收缩指数(ICON)、收缩时间比(STR)等NHM-BIA指标采用成组t检验、Mann-Whitney U检验与χ^(2)检验进行统计学比较。对NS患儿并发CD的影响因素进行多因素非条件logistic回归分析。绘制NHM-BIA不同指标预测NS患儿并发CD的受试者工作特征(ROC)曲线,并计算曲线下面积(AUC)。根据约登指数最大原则,确定这些指标预测NS患儿并发CD的最佳临界值。本研究遵循的程序符合本院伦理委员会规定,通过本院伦理委员会审查,并获得批准(审批文号:20210034)。2组NS患儿性别构成比、出生胎龄、出生体重等一般临床资料比较,差异均无统计学意义(P>0.05)。结果①研究组患儿危重新生儿比例及血清NT-proBNP、hs-cTn水平,均显著高于对照组,并且差异均有统计学意义(P<0.05)。②研究组NS患儿心率、SVV、SVR、SVRI、STR,均显著高于对照组,而SI、心指数、FTC、ICON,均显著低于对照组,并且差异均有统计学意义(P<0.05)。③多因素非条件logistic回归分析结果显示,血清NT-proBNP、hs-cTn水平高,是NS患儿并发CD的独立危险因素(OR=1.001、1.095,95%CI:1.000~1.001、1.047~1.146,P均<0.001),而心指数高是NS患儿并�Objective To explore value of non-invasive hemodynamic monitoring by bioelectrical impedance analysis(NHM-BIA)in predicting neonatal sepsis(NS)complicated with cardiac dysfunction(CD).Methods A total of 152 children with NS who were admitted to neonatal intensive care unit(NICU)of Affiliated Children′s Hospital of Xi′an Jiaotong University from January 2017 to November 2020 were selected as research subjects.They were divided into study group(n=53,complicated with CD)and control group(n=99,without CD)according to whether they were complicated with CD or not by retrospective analysis method.The gender,gestational age at birth,weight at birth,proportion of critically ill neonates,serum N-terminal pro-brain natriuretic peptide(NT-proBNP),high sensitive cardiac troponin(hs-cTn),and creatine kinase isoenzyme MB(CK-MB),atrial and ventricular diameter and ejection fraction,as well as heart rate,stroke volume index(SI),cardiac output(CO),cardiac index,stroke volume variability(SVV),flow time of corrected(FTC),systemic vascular resistance(SVR),systemic vascular resistance index(SVRI),index of contractility(ICON),systolic time ratio(STR)of two groups were compared by independent-samples t test,Mann-Whitney U test and chi-square test.Multivariate unconditional logistic regression analysis was used to analyze the influencing factors of NS complicated with CD in neonates.Receiver operating characteristics(ROC)curves of different indexes of NHM-BIA to predict NS complicated with CD were drawn,and area under the curve(AUC)was calculated.According to principle of maximum Youden index,the best critical value of different indexes for predicting NS complicated with CD were determined.The procedures followed in this study met the standards formulated by the Ethics Review Committee of Affiliated Children′s Hospital of Xi′an Jiaotong University and has been approved by it(Approval No.20210034).There were no significant differences in general clinical data of neonates with NS between two groups,such as gender composition ratio,

关 键 词：脓毒症 心功能障碍 血流动力学 无创血流动力学监测 胸腔生物电阻抗法 利钠肽 脑 肌钙蛋白 婴儿 新生 

分 类 号：R72[医药卫生—儿科]