灌注指数监测新生儿血流动力学的有效性研究

目的 分析灌注指数(PI)监测新生儿循环的有效性,为新生儿循环监测寻找一种敏感、简便的方法。 方法 选择2018年10月—2019年7月入住新乡市中心医院新生儿重症监护室(NICU)的新生儿,入院后进行新生儿危重病评分(NCIS),评分＞90分为非危重,70～90分为危重,＜70分为极危重。选择病情危重和极危重时进行有创动脉血压监测的患儿54例,记录平均动脉压(MAP),并同时监测PI、动脉血乳酸值、心率、SPO₂和左室射血分数(EF)。 结果 1)PI与MAP之间呈中度正相关(r=0.724,P＜0.01),与血乳酸之间呈中度负相关(r=-0.688,P＜0.01),与心率、SPO₂、左室射血分数(EF)之间无相关性;2)PI与MAP之间ROC曲线分析示:截断点0.67,敏感性87.8%,特异性76.9%,AUC 0.872(P＜0.01);3)PI与血乳酸之间ROC曲线分析示:截断点1.35,敏感性100.0%,特异性77.3%,AUC 0.931,P＜0.01。 结论 PI是监测新生儿循环的敏感指标。

Study on the effectiveness of perfusion index in neonatal hemodynamic monitoring

Objective To explore the effectiveness of perfusion index (PI) in monitoring neonatal circulation,so as to find out a sensitive and easy way for circulation monitoring of neonates. Methods Newborns admitted to the Neonatal Intensive Care Unit (NICU) of Xinxiang Central Hospital from October 2018 to July 2019 were selected,and the neonatal critical illness score (NCIS) was performed after admission. The score >90 was non-critical,the score between 70 and 90 was critical,and the score<70 was extremely critical. Fifty-four children who were in critical or extremely critical condition and underwent invasive blood pressure monitoring with the consent and signature of their families were selected and included in the study. Mean arterial pressure (MAP) was recorded,and PI,blood lactic acid,heart rate,SPO₂ and left ventricular ejection fraction (EF) were monitored simultaneously. Results 1)There was a moderate positive correlation between PI and MAP (r=0.724,P=0.01) and a moderate negative correlation between PI and blood lactic acid (r=-0.688,P<0.01). The correlation between PI and heart rate,SPO₂,left ventricular ejection fraction (EF) was not significant. ROC curve showed that when the cut-off point of PI was 0.67,the sensitivity and specificity of PI for predicting MAP were 87.8% and 76.9%,with the AUC of 0.872 (P<0.01). When the cut-off point of PI was 1.35,the sensitivity and specificity of PI for predicting blood lactic acid were 100.0% and 77.3%,with the AUC of 0.931(P<0.01). Conclusions PI is a sensitive index for monitoring neonatal circulation.