用Tei指数联合校正QT离散度和B型钠尿肽评估无创正压通气对早产儿心功能影响的前瞻性研究  

Effects of noninvasive positive pressure ventilation on cardiac function in premature infants using Tei index combined with correction of QT dispersion and B-type natriuretic peptide:a prospective study

作　　者：杨波 佟念念 雷红林 金宝[1] 任漪 李丽[1] 赵丹丹 王乐瑶 高翔羽[1] Bo Yang;Niannian Tong;Honglin Lei;Bao Jin;Yi Ren;Li Li;Dandan Zhao;Leyao Wang;Xiangyu Gao(Department of Neonatology,Xuzhou Central Hospital,Jiangsu Province,Xuzhou Clinical College of Xuzhou Medical University,Xuzhou 221009,China;Department of Cardiac Function,Xuzhou Central Hospital,Jiangsu Province,Xuzhou Clinical College of Xuzhou Medical University,Xuzhou 221009,China)

机构地区：[1]江苏省徐州市中心医院(徐州医科大学徐州临床学院)新生儿科,徐州221009 [2]江苏省徐州市中心医院(徐州医科大学徐州临床学院)心功能科,徐州221009

出　　处：《中华围产医学杂志》2022年第6期424-432,共9页Chinese Journal of Perinatal Medicine

基　　金：江苏省妇幼健康科研项目(F201752);徐州市科技局重点研发计划(KC18188);江苏省卫生健康委科研项目(Z2020060)。

摘　　要：目的:探讨以Tei指数联合校正QT离散度(corrected QT dispersion,QTcd)和B型钠尿肽(B-type natriuretic peptide,BNP)评估无创正压通气对早产儿心功能的影响。方法:本研究为前瞻性研究。研究对象为2017年12月至2020年12月徐州市中心医院新生儿重症监护病房收治的、接受无创正压通气的胎龄28~32周呼吸窘迫综合征(respiratory distress syndrome,RDS)早产儿。根据使用无创正压通气设置的平均气道压(mean airway pressure,MAP),分为低压组(≤6 cmH 2O,1 cmH 2O=0.098 kPa)、中压组(>6~<9 cmH 2O)和高压组(≥9 cmH 2O)。监测无创正压通气0~2 h内及使用稳定的MAP持续通气12 h后右心室Tei指数、QTcd和血BNP。采用 χ^(2)检验、单因素方差分析、配对 t检验和积矩相关性分析等进行统计分析。 结果:(1)共178例进入本研究,其中低压组75例,中压组62例,高压组41例。(2)使用稳定的MAP持续通气12 h后,高压组右心室Tei指数和QTcd大于中压组和低压组[Tei指数:(0.38±0.05)与(0.33±0.04)和(0.33±0.04), F=29.18;QTcd:(27.6±4.2)与(22.8±4.4)和(22.2±4.2)ms, F=23.26;P值均<0.001];中压组右心室Tei指数和QTcd与低压组相比,差异均无统计学意义;3组血BNP水平差异亦无统计学意义( F=1.33, P=0.267)。(3)与无创正压通气0~2 h内相比,使用稳定的MAP持续通气12 h后,高压组右心室Tei指数和QTcd增大[Tei指数:(0.38±0.05)与(0.34±0.04), t=-6.61;QTcd:(27.6±4.2)与(23.4±4.4)ms, t=-5.06, P值均<0.001];中压组与低压组右心室Tei指数和QTcd变化不明显( P值均>0.05);3组持续通气12 h后血BNP水平与0~2 h内相比,未见明显变化( P值均>0.05)。(4)右心室Tei指数和QTcd与MAP呈中度正相关关系( r值分别为0.56和0.50, P值均<0.001)。 结论:当MAP<9 cmH 2O时,无创正压通气对RDS早产儿心功能无明显影响;较高压力(MAP≥9 cmH 2O)、较长时间(>12 h)的无创正压通气,对RDS早产儿右心功能有一定影响。Objective To assess the effects of noninvasive positive pressure ventilation on premature infants'cardiac function using Tei index combined with corrected QT dispersion(QTcd)and B-type natriuretic peptide(BNP).Methods This prospective study involved premature infants from 28 to 32 weeks of gestational age diagnosed with respiratory distress syndrome(RDS)and treated with noninvasive positive pressure ventilation in the Neonatal Intensive Care Unit of Xuzhou Central Hospital from December 2017 to December 2020.According to the mean airway pressure(MAP)during noninvasive positive pressure ventilation,the patients were divided into the low-pressure group(≤6 cmH2O,1 cmH2O=0.098 kPa),medium-pressure group(>6-<9 cmH2O),and high-pressure group(≥9 cmH2O).The right ventricular Tei index,QTcd,and blood BNP were monitored during the first 2 h of noninvasive positive pressure ventilation and 12 h after continuous ventilation with stable MAP.Chi-square test,one-way analysis of variance,paired t-test,and Pearson product-moment correlation coefficient were adopted for statistical analysis.Results Totally 178 premature infants were enrolled,including 75 in the low-pressure,62 in the medium-pressure,and 41 in the high-pressure group.After continuous ventilation with stable MAP for 12 h,the right ventricle Tei index and QTcd in the high-pressure group were higher than those in the medium-and low-pressure group[Tei index:(0.38±0.05)vs(0.33±0.04)and(0.33±0.04),F=29.18;QTcd:(27.6±4.2)vs(22.8±4.4)and(22.2±4.2)ms,F=23.26,all P<0.001],and the comparison between the medium-and the low-pressure group did not differ significantly.No significant difference was observed in blood BNP levels among the three groups(F=1.33,P=0.267).The right ventricle Tei index and QTcd increased in the high-pressure group after continuous ventilation with stable MAP for 12 h as compared with those within the first 2 h of noninvasive positive pressure ventilation[Tei index:(0.38±0.05)vs(0.34±0.04),t=-6.61;QTcd:(27.6±4.2)vs(23.4±4.4)ms,t=-5.06,all P<

关 键 词：正压呼吸 心室功能 超声心动描记术 多普勒 心电描记术 利钠肽 脑 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]