脉搏血氧灌注指数及脉搏灌注变异指数在指导危重新生儿撤离呼吸机中的应用  

Application of perfusion index and pleth variability index on the instructions of ventilator weaning for critically ill neonates

作　　者：陈小琴 张卫星 刘雪琴 CHEN Xiao-qin;ZHANG Wei-xing;LIU Xue-qin(Department of Neonatal Intensive Care Unit,Xinxiang Central Hospital,Xinxiang 453000,Henan,China)

机构地区：[1]新乡市中心医院(新乡医学院第四临床学院)新生儿重症监护病房,河南新乡453000

出　　处：《广东医学》2022年第11期1337-1340,共4页Guangdong Medical Journal

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20191319,2018020926)。

摘　　要：目的研究脉搏血氧灌注指数(PI)和脉搏灌注变异指数(PVI)在指导危重新生儿撤离呼吸机中的应用价值。方法临床纳入2020年6月至2021年6月收治的118例危重机械通气新生儿作为研究对象,根据新生儿撤机情况分为撤机成功组(n=82)和撤机失败组(n=36)。所有危重新生儿均进行PI、PVI监测,观察两组患儿的PI和PVI水平、预后指标以及撤机参数,分析PI和PVI在危重新生儿撤离呼吸机中的应用价值。结果撤机成功组患儿PI水平明显高于撤机失败组,PVI水平低于撤机失败组,差异均有统计学意义(P<0.05)。撤机成功组患儿机械通气时间和住院时间均短于撤机失败组患儿,差异有统计学意义(P<0.05)。撤机成功组患儿膈肌位移距离大于撤机失败组,膈肌浅快呼吸指数(diaphragmatic-rapid shallow breathing index,D-RSBI)及浅快呼吸指数(rapid shallow breathing index,RSBI)水平均低于撤机失败组,差异均有统计学意义(P<0.05)。PI与PVI预测撤机失败的AUC对比差异无统计学意义(P>0.05),且敏感度、特异度均较高,预测价值较高。结论PI、PVI水平能有效预测撤机失败,对指导危重新生儿撤离呼吸机具有重要指导意义。Objective To study the clinical value of perfusion index(PI)and pleth variability index(PVI)on the instructions of ventilator weaning for critically ill neonates.Methods A total of 118 critically ill neonates with mechanical ventilation from June 2020 to June 2021 were selected.According to weaning conditions,neonates were assigned to success group(n=82)and failed group(n=36).PI and PVI,prognostic indicators and relevant parameters were monitored.The applied value of PI and PVI on the instructions of ventilator weaning was studied.Results PI in success group was significantly higher than that in failed group;while PVI was significantly lower than failed group(P<0.05).The mechanical ventilation time and hospital stay in success group were significantly shorter than failed group(P<0.05).The diaphragm displacement distance in success group was significantly longer than failed group;and diaphragmatic-rapid shallow breathing index(D-RSBI)and rapid shallow breathing index(RSBI)values were significantly lower than failed group(P<0.05).Area under the curve(AUC)for predicting the failed weaning based on PI and PVI was not significantly different(P>0.05).PI and PVI had higher diagnosis sensitivity,specificity and predictive value for the failed weaning.Conclusion PI and PVI are effective and significant to predict the ventilator weaning condition for critically ill neonates.

关 键 词：脉搏血氧灌注指数 脉搏灌注变异指数 新生儿 呼吸机 

分 类 号：R722.19[医药卫生—儿科] R720.597[医药卫生—临床医学]