Page 71 - 中国全科医学2022-08

·964· http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn

Objective To examine predictive value of the hemodynamic indexes for BPD in premature infants. Methods One hundred and
sixty-one premature infants（hospitalized within 1 hour of birth，gestational age <32 weeks）were selected from Xinxiang Central
Hospital from September 2018 to December 2020. The general data（gestational age，birth weight，sex，and mode of delivery）
were collected；the basic diseases and other complications of preterm infants were collected，compared between two groups of
infants divided by the prevalence of BPD（n=65）or not（n=96）. PI values（measured at 1，12，48，72 and 96 hours after
delivery，and on the 5th，6th，and 7th days after delivery，respectively），and serum lactic acid levels（measured at 1，12，
and 24 hours after admission，respectively）were collected. Mean arterial pressure（MAP）levels measured by arterial pressure
monitoring at 1，12 and 24 hours after admission for 33 infants（16 in BPD group and 17 in the control group）with critical or
extremely critical conditions suggested by neonatal critical illness score were also collected. Compare the results between two
groups，the receiver operating characteristic（ROC）curve was plotted to evaluate the predictive value of PI，serum lactic acid
and MAP for BPD in preterm infants. Results Sixty-five out of the 161 cases 〔40.3%（65/161）〕were diagnosed with BPD.
Preterm infants with and without BPD had no statistically significant differences in gestational age，birth weight，gender，and
mode of delivery（P>0.05）. Preterm infants with BPD had higher incidence of neonatal asphyxia，neonatal respiratory distress
syndrome，neonatal pneumonia，and retinopathy of prematurity than those without（P<0.05）. Preterm infants with and without
BPD had no statistically significant differences in sepsis，pulmonary hemorrhage，PDA，IVH，purulent meningitis and anemia
（P>0.05）. PI values at 1，12 and 24 hours after birth differed significantly between the two groups（P<0.05）. Serum lactic
acid at 1 hour after admission differed significant between the two groups（P<0.05）. MAP levels at different time periods showed
no significant differences between critical and extremely critical preterm infants with and without BPD（P>0.05）. In predicting
BPD，the PI at 1-hour，12-hour，and 24-hour was 0.847〔95%CI（0.788，0.906），P<0.001〕，0.776〔95%CI（0.705，
0.846），P<0.001〕，0.695〔95%CI（0.613，0.778），P<0.001〕，respectively；the optimal cutoff value was chosen as 0.55，
1.15，1.45，with the sensitivity of 76.9%，86.2%，81.5% and the specificity of 75.0%，60.4%，51.0%；serum lactic acid at 1
hour after birthhad an AUC of 0.762〔95%CI（0.686，0.837），P<0.001〕，the optimal cutoff value was chosen as 6.55，with
the sensitivity of 81.5%，and the specificity of 68.7%. Conclusion In preterm infants with a gestational age <32 weeks，the
change of hemodynamic indicatou PI and lactic acid value maybe correlated with the occurrence of BPD. PI value within 24 hours
after birth may be an earlypredictor for BPD，but further research is still needed.
【Key words】 Bronchopulmonary dysplasia；Infant，remature；Hemodynamics；Perfusion index；Lactic acid；Mean
arterial pressure；Forecasting

支气管肺发育不良（BPD）是早产儿常见的慢性肺 本文的创新点：
部疾病。随着我国极早产儿和超早产儿存活率的逐渐升 （1）本文通过分析脉搏灌注指数（PI）、血乳
高，BPD 的发生率也逐年上升，严重影响早产儿生命安 酸值和平均动脉压（MAP）与早产儿支气管肺发育不
全及生存质量。BPD 的发生与多种因素有关，国内外学 良（BPD）之间的相关性，证实早产儿出生后 24 h 内
者多认为其本质是各种不利因素（如氧中毒、炎症及气 PI 对发生 BPD 有一定的预测价值，值得临床关注；
压伤等）对早产儿发育不成熟的肺造成慢性损伤，导致 （2）PI 是脉搏血氧饱和度仪新增的参数，可以反映
肺泡和肺血管发育受阻，以及肺组织和肺血管受损后的 早产儿血流动力学状态。与血乳酸值及 MAP 检测相
异常修复 ［1-2］ 。微循环灌注不足、组织缺氧、生命器官 比，PI 监测具有无创、操作简便、实时连续等优点，
能量供需失衡，均可引起早产儿肺部毛细血管缺血、缺 适合在新生儿中应用，具有较强的临床实用价值；（3）
氧，肺泡组织发育不良，最终可导致 BPD 的发生 ［3］ 。 在实际临床工作中，若能早期发现血流动力学指标不
通过监测血流动力学指标变化以预测 BPD 发生的方法 稳定及外周组织灌注不足，并进行相应临床干预，可
少有报道。脉搏灌注指数（PI）是脉搏血氧饱和度仪新 能会降低 BPD 发生率。
增的反映外周组织灌注情况的指标，可以反映早产儿血 本文的局限性：
流动力学状态；乳酸是机体无氧代谢的产物，可以反映 本研究为单中心研究，纳入的样本量相对较少；
机体的真实灌注情况和氧合状态；平均动脉压（MAP） 研究只记录了出生后 1 周的 PI 值，记录时间较短。
是临床上常用的宏观血流动力学指标，可以反映各脏器 还需进一步开展多中心、大样本的研究加以验证。
血液灌注的情况。本研究主要探讨围生期早产儿血流动
力学指标与 BPD 发生的相关性，分析 PI、血乳酸值及 1 对象与方法
MAP 对早产儿发生 BPD 的预测价值。 1.1 研究对象 选取 2018 年 9 月至 2020 年 12 月新乡