肺泡动脉氧分压差在晚期早产儿和足月儿急性呼吸窘迫综合征中的临床意义  

Clinical significance of alveolar-arterial oxygen gradients for late preterm and full-term infants with acute respiratory distress syndrome

作　　者：冀璐[1] 王晓林[1] 李亚蕊[2] 杨慧敏 Ji Lu;Wang Xiaolin;Li Yarui;Yang Huimin(Department of Neonatal Medcine,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Pediatrics,Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学附属第二医院新生儿科,太原030001 [2]山西医科大学儿科系,太原030001

出　　处：《中华新生儿科杂志（中英文）》2023年第9期550-554,共5页Chinese Journal of Neonatology

摘　　要：目的探讨肺泡动脉氧分压差(alveolar-arterial oxygen gradient,P_(A-a)O_(2))在晚期早产儿和足月儿急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)中的临床意义。方法选择2020年1月至2022年6月山西医科大学附属第二医院出生并收入新生儿科、胎龄≥34周的ARDS新生儿进行回顾性研究,按照病程中的呼吸支持模式分为有创组和无创组,选取同期收治的同胎龄湿肺新生儿为对照组,比较3组生后1 h内P_(A-a)O_(2)水平,分析P_(A-a)O_(2)与ARDS、机械通气方式及时间的相关性,采用受试者工作特征(receiver operating characteristic,ROC)曲线评价生后1 h内P_(A-a)O_(2)水平对发生ARDS以及需要有创通气的预测价值。结果共纳入有创组36例,无创组19例,对照组50例。有创组生后1 h内P_(A-a)O_(2)水平高于无创组和对照组,无创组高于对照组(P<0.05)。相关性分析显示,有创组生后1 h内P_(A-a)O_(2)水平与有创通气时间、总机械通气时间均呈正相关(r=0.601,P<0.001;r=0.504,P=0.002),成功撤离有创通气前的P_(A-a)O_(2)水平与后续无创通气时间无相关性;无创组生后1 h内P_(A-a)O_(2)水平与无创通气时间无相关性。生后1 h内P_(A-a)O_(2)水平预测ARDS的ROC曲线下面积为0.875,截断值为50.0 mmHg时,敏感度为87.3%,特异度为72.0%;预测ARDS患儿需要有创通气的ROC曲线下面积为0.851,截断值为73.3 mmHg时,敏感度为80.0%,特异度为75.0%。结论晚期早产儿和足月儿生后1 h内P_(A-a)O_(2)>50.0 mmHg时发生ARDS的风险更高;P_(A-a)O_(2)>73.3 mmHg时ARDS患儿需要有创通气的可能性更大;生后1 h内P_(A-a)O_(2)水平越高,有创通气时间和总机械通气时间可能越长。Objective To study the clinical significance of alveolar-arterial oxygen gradients(P_(A-a)O_(2))for late preterm and full-term infants with acute respiratory distress syndrome(ARDS).Methods From January 2020 to June 2022,infants(gestational age≥34 weeks)diagnosed with ARDS were admitted to the Neonatology Department of our hospital.The infants were assigned into the invasive group and the non-invasive group according to the ventilation mode.The infants with the same gestational age and diagnosed with neonatal wet lung were assigned into the control group.P_(A-a)O_(2) levels within 1 h after birth were compared among the three groups.The correlation of P_(A-a)O_(2) with ARDS,ventilation mode and duration were studied.Receiver operating characteristic(ROC)curve was used to determine the predictive value of P_(A-a)O_(2) within 1 h after birth for ARDS and the need of invasive ventilation.Results A total of 36 cases were enrolled in the invasive group,19 cases in the non-invasive group and 50 cases in the control group.Within 1 h after birth,P_(A-a)O_(2) in the invasive group was significantly higher than the non-invasive group and the control group(P<0.05),and the non-invasive group higher than the control group(P<0.05).Correlation analysis showed that P_(A-a)O_(2) within 1 h after birth in the invasive group was positively correlated with the duration of invasive ventilation and total mechanical ventilation(r=0.601,P<0.001;r=0.504,P=0.002);P_(A-a)O_(2) before successful withdrawal of invasive ventilation was not correlated with subsequent non-invasive ventilation duration;and no correlation existed between P_(A-a)O_(2) within 1 h after birth and the duration of non-invasive ventilation in the non-invasive group.The area under the ROC curve for P_(A-a)O_(2) within 1 h after birth to predict ARDS was 0.875,with a sensitivity of 87.3%and a specificity of 72.0%at a cutoff value of 50.0 mmHg.The area under the ROC curve for predicting the need for invasive ventilation in infants with ARDS was 0.851,with a sensitivity

关 键 词：肺泡动脉氧分压差 晚期早产儿 足月儿 急性呼吸窘迫综合征 

分 类 号：R722.6[医药卫生—儿科]