动态监测经皮血气分析指标和炎性指标对新生儿呼吸窘迫综合征并发支气管肺发育不良的预测价值  

Predictive value of dynamic monitoring of transcutaneous blood gas analysis and inflammatory indicators for bronchopulmonary dysplasia in neonatal respiratory distress syndrome

作　　者：杨华蕾[1] 王小雷 田金凤 魏培培 聂军红 YANG Hualei;WANG Xiaolei;TIAN Jinfeng;WEI Peipei;NIE Junhong(the Second People′s Hospital of Hengshui of Hebei Province,Hengshui,Hebei,053000)

机构地区：[1]河北省衡水市第二人民医院,河北衡水053000

出　　处：《实用临床医药杂志》2024年第14期60-66,共7页Journal of Clinical Medicine in Practice

基　　金：河北省衡水市科技计划项目(2022014086Z)。

摘　　要：目的探讨动态监测经皮氧分压[p_(tc)(O_(2))]、经皮二氧化碳分压[p_(tc)(CO_(2))]与血清淀粉样蛋白A(SAA)、白细胞介素-6(IL-6)水平对新生儿呼吸窘迫综合征(NRDS)患儿并发支气管肺发育不良(BPD)的预测价值。方法选取240例NRDS患儿作为研究对象,根据是否并发BPD分为BPD组108例和非BPD组132例。比较2组患儿出生后第1、7、14天时p_(tc)(O_(2))、p_(tc)(CO_(2))、SAA、IL-6水平,采用Spearman相关分析法探讨各指标间的相关性及其与病情程度的相关性,采用相对危险度(RR)和95%置信区间(CI)评价各指标对NRDS患儿并发BPD的影响,采用受试者工作特征(ROC)曲线、决策曲线分析各指标预测BPD的效能及临床净获益。结果出生后第1天,2组患儿p_(tc)(O_(2))、p_(tc)(CO_(2))和血清SAA、IL-6水平比较,差异均无统计学意义(P>0.05);出生后第7、14天,BPD组p_(tc)(O_(2))低于非BPD组,p_(tc)(CO_(2))和血清SAA、IL-6水平高于非BPD组,差异有统计学意义(P<0.05)。相关性分析结果显示,患儿BPD程度与出生后第7天时p_(tc)(O_(2))呈负相关(r=-0.724,P<0.05),与出生后第7天时p_(tc)(CO_(2))、SAA、IL-6呈正相关(r=0.635、0.830、0.715,P<0.05);患儿肺功能障碍程度与出生后第7天时p_(tc)(O_(2))呈负相关(r=-0.719,P<0.05),与出生后第7天时p_(tc)(CO_(2))、SAA、IL-6呈正相关(r=0.673、0.756、0.696,P<0.05);出生后第7天时,BPD患儿p_(tc)(O_(2))分别与SAA、IL-6呈负相关(r=-0.605、-0.623,P<0.05),p_(tc)(CO_(2))分别与SAA、IL-6呈正相关(r=0.618、0.650,P<0.05)。ROC曲线显示,出生后第7天p_(tc)(O_(2))、p_(tc)(CO_(2))、SAA、IL-6联合预测NRDS并发BPD的效能优于四者单独预测,曲线下面积为0.938(95%CI:0.899~0.965)。p_(tc)(CO_(2))、SAA、IL-6高表达者并发BPD的风险是低表达者的2.256、1.668、1.667倍,p_(tc)(O_(2))高表达者并发BPD的风险是低表达者的0.568倍。决策曲线分析结果显示,当阈值在0.2~0.9时,出生后第7天时p_(tc)(O_(2))、p_(tc)(CO_(2))、SObjective To investigate the predictive value of dynamic monitoring of transcutaneous oxygen partial pressure[p_(tc)(O_(2))],transcutaneous carbon dioxide partial pressure[p_(tc)(CO_(2))],serum amyloid A(SAA),and interleukin-6(IL-6)levels in predicting bronchopulmonary dysplasia(BPD)in neonates with neonatal respiratory distress syndrome(NRDS).Methods A total of 240 NRDS patients were selected as the research subjects and divided into BPD group(108 cases)and non-BPD group(132 cases)based on whether BPD occurred.The levels of p_(tc)(O_(2)),p_(tc)(CO_(2)),SAA,and IL-6 were compared between the two groups on the 1st,7th,and 14th day after birth.Spearman correlation analysis was used to explore the correlation between each indicator and the degree of illness.The relative risk(RR)and 95%confidence interval(CI)were used to evaluate the impact of each indicator on BPD in NRDS patients.Receiver operating characteristic(ROC)curves and decision curve analysis were used to evaluate the predictive efficacy and clinical net benefit of each indicator for BPD.Results On the 1st day after birth,there were no statistically significant differences in p_(tc)(O_(2)),p_(tc)(CO_(2)),serum SAA,and IL-6 levels between the two groups(P>0.05).On the 7th and 14th day after birth,the p_(tc)(O_(2))in the BPD group was lower than that in the non-BPD group,while the p_(tc)(CO_(2))and serum SAA,IL-6 levels were higher than those in the non-BPD group(P<0.05).Correlation analysis results showed that the degree of BPD in children was negatively correlated with p_(tc)(O_(2))on the 7th day after birth(r=-0.724,P<0.05),and positively correlated with p_(tc)(CO_(2)),SAA,and IL-6 on the 7th day after birth(r=0.635,0.830,0.715,P<0.05).The degree of pulmonary dysfunction in children was negatively correlated with p_(tc)(O_(2))on the 7th day after birth(r=-0.719,P<0.05),and positively correlated with p_(tc)(CO_(2)),SAA,and IL-6 on the 7th day after birth(r=0.673,0.756,0.696,P<0.05).On the 7th day after birth,the p_(tc)(O_(2))of BPD patients was negatively

关 键 词：新生儿呼吸窘迫综合征 支气管肺发育不良 经皮氧分压 经皮二氧化碳分压 淀粉样蛋白A 白细胞介素-6 

分 类 号：R722.1[医药卫生—儿科] R446[医药卫生—临床医学] R56