氧储备指数：氧疗监测的新方法

氧储备指数（oxygen reserve index,ORI）是一项新型无量纲参数,可无创、实时、持续监测氧合状态,数值范围是0~1,反映的动脉血氧分压范围是100~200 mmHg。ORI和脉搏血氧仪结合使用,有助于准确调整吸入气氧浓度,预防低氧血症和高氧血症。ORI适用于临床各种情况,医务人员应掌握这项新型参数并合理应用,以评估患者的氧合状态。临床应用时应注意ORI的一些不足。     

Oxygen and Reduced Umbilical Blood Flow Trigger the First Breath of Human Neonates

The mechanism triggering the first breath of human neonates is still unclear. In order to investigate the role of oxygen and umbilical blood flow in the onset of the first breath, a total of 20 rat and rabbit fetuses were studied. AH five rat fetuses delivered in a nitrogen chamber did not commence breathing of their own accord, whereas all five rabbit fetuses delivered in oxygenated fluorocarbon fluid commenced their own breathing, suggesting that contact with oxygen rather than release from submergence is more crucial in the initiation of the first breath.     

早产儿氧疗监护观察

目的 检测不同输氧方式、不同氧流量、不同环境的吸入氧浓度值,从而取得适合早产儿氧疗的吸入氧浓度值及氧疗方式.方法 采取专人统一条件应用双鼻导管、头罩(普通型、法斯特头罩)、氧帐在不同暖箱中,采取不同氧流量进行氧浓度的监测,并进行氧浓度值的比较,以选择何种氧疗方式更适合于早产儿.结果 双鼻导管吸氧在0.5 L/min、1 L/min、2 L/min普通法氧浓度均＞95%,改良法氧浓度均＞60%并随氧流量增加而升高,但两种方法吸氧浓度差异有统计学意义(P＜0.05);头罩吸氧3～5 L/min流量的氧浓度均＜50%,在3种暖箱中氧浓度无明显差异;氧帐吸氧中各氧流量的氧浓度均＜30%,在3种暖箱中氧浓度无明显差异;法斯特头罩吸氧的氧浓度与所标记值基本相符.结论 流量＜5 L/min头罩氧帐和法斯特头罩用于早产儿氧疗比较安全,而双鼻导管吸氧不适合早产儿氧疗.     

The value of oxygen index and base excess in predicting the outcome of neonatal acute respiratory distress syndrome

ObjectiveThis study aimed to identify the predictors and threshold of failure in neonatal acute respiratory distress syndrome.MethodsNewborns with severe acute respiratory distress syndrome aged 0–28 days and gestational age ≥36 weeks were included in the study if their cases were managed with non-extra corporal membrane oxygenation treatments. Patients were divided into two groups according to whether they died before discharge. Predictors of non-extra corporal membrane oxygenation treatment failure were sought, and the threshold of predictors was calculated.ResultsA total of 103 patients were included in the study. A total of 77 (74.8%) survived hospitalization and were discharged, whereas 26 (25.2%) died. Receiver operating characteristic analysis of oxygen index, pH, base excess, and combinations of these indicators demonstrated the advantage of the combination of oxygen index and base excess over the others variables regarding their predictive ability. The area under the curve for the combination of oxygen index and base excess was 0.865. When the cut-off values of oxygen index and base excess were 30.0 and ?7.4, respectively, the sensitivity and specificity for predicting death were 77.0% and 84.0%, respectively. The model with base excess added a net reclassification improvement of 0.090 to the model without base excess.ConclusionThe combination of oxygen index and base excess can be used as a predictor of outcomes in neonates receiving non-extra corporal membrane oxygenation treatment for acute respiratory distress syndrome. In neonates with acute respiratory distress syndrome, if oxygen index >30 and base excess <?7.4, non-extra corporal membrane oxygenation therapy is likely to lead to death.     

Smoking and metabolic control in adolescents with type 1 diabetes

OBJECTIVE: To relate self-reported smoking frequency to metabolic control and other cardiovascular risk factors in adolescents with type 1 diabetes. STUDY DESIGN: In the multicenter Diabetes Patienten Verlaufsdokumentationssystem database from Germany and Austria, anonymized records on 27 561 patients < 20 years of age with documented smoking status were available for analysis. RESULTS: Self-reported smoking was negligible in patients younger than 11 years (0.1%), increasing to 5% in 11- to 15-year-old patients, and 28.4% in the 15- to 20-year-old age group. Multivariate analysis with adjustment for age, diabetes duration, sex, insulin therapy, and center differences, revealed that smokers had higher HbA1c-levels compared with non-smokers (9.1% vs 8.0%, P < .0001). Diastolic blood pressure was higher (68.2 vs 67.6 mm Hg, P < .0001), and the lipid profile was unfavorable in patients who smoke: Triglycerides and total cholesterol were higher and high-density lipoprotein-cholesterol was lower (all P < .0001). CONCLUSIONS: Smokers display significantly worse metabolic control and a higher cardiovascular risk profile. Although not attested in trials, we state that education about smoking, smoking prevention, and psychological help for smoking cessation should be an integral part of comprehensive pediatric care for adolescent patients with type 1 diabetes.     

Vagal activity, gastric motility, and weight gain in massaged preterm neonates

OBJECTIVE: Multiple studies have documented an increase in weight gain after 5 to 10 days of massage therapy for preterm neonates. The massaged preterm neonates did not consume more calories than the control neonates. One potential mechanism for these effects might involve massage-induced increases in vagal activity, which in turn may lead to increased gastric motility and thereby weight gain. STUDY DESIGN: The present randomized study explored this potential underlying mechanism by assessing gastric motility and sympathetic and parasympathetic nervous system activity in response to massage therapy (moderate pressure) versus sham massage (light pressure) and control conditions in a group of preterm neonates. RESULTS: Compared with preterm neonates receiving sham massage, preterm neonates receiving massage therapy exhibited greater weight gain and increased vagal tone and gastric motility during and immediately after treatment. Gastric motility and vagal tone during massage therapy were significantly related to weight gain. CONCLUSION: The weight gain experienced by preterm neonates receiving moderate-pressure massage therapy may be mediated by increased vagal activity and gastric motility.     

超长期需氧疗新生儿资料分析

目的 了解新生儿重症监护室内新生儿用氧情况及长期需氧疗发生率及临床特点.方法 回顾性分析2009年10月至2011年5月我院新生儿重症监护室收治的12 155例新生儿用氧情况及相关临床资料,并与国内19所医院调查结果进行比较.结果 在纳入的12 155例新生儿中,足月儿4 951例,早产儿7 204例,共有102例用氧超过28 d,发生率为0.84％(102/12 155).102例患儿中,早产儿88例,足月儿14例;出生胎龄(31.16±3.70)周;出生体重(1.60±0.68) kg;用氧时间(40.62±12.25)d;治愈或好转98例,死亡4例.7204例早产儿按持续吸氧超过生后28 d的标准,支气管肺发育不良(bronchopulmonary dysplasia,BPD)发生率为1.22％(88/7204).出生胎龄32周以下的早产儿,如以需氧疗时间超过生后28 d为标准,BPD发生率为4.92％(68/1 381),如以需氧疗时间超过矫正胎龄36周为标准,BPD发生率仅为2.10％(29/1 381),两者BPD发生率比较差异有统计学意义(x2=16.251,P＜0.001).整体比较5 499例不同出生胎龄患儿的用氧比例(x2=119.99)、吸氧持续时间(F=109.27),差异均有统计学意义(P＜0.001),但不同胎龄长期氧依赖患儿的平均用氧和机械通气时间差异无统计学意义(P＞0.05).不同胎龄的长期氧依赖患儿在肺表面活性物质应用、心力衰竭、早产儿视网膜病变、先天性心脏病及其他先天畸形发生率和预后方面差异有统计学意义(x2=8.789,13.538,23.176,7.778,8.842,8.246,P＜0.05).我院与国内19所医院调查数据比较,患儿校正超长期用氧率分别为0.99％ (71/7 204)和1.54％( 190/12 351),差异有统计学意义(x2=10.558,P＜0.001).结论 我院住院早产儿BPD发生率较低.胎龄小、肺发育不成熟及继发的肺损伤可能是需超长期用氧的主要原因.较大胎龄新生儿长期氧依赖应注意除外先天性心脏病、先天畸形等因素.胎龄32周以下早产儿BPD诊断标准仍有待商榷.