目的比较早产儿和足月儿持续性肺动脉高压(persistent pulmonary hypertension of the newborn,PPHN)发病的高危因素及预后,以指导PPHN的防治。方法本研究为单中心回顾性研究,收集2010年1月1日至2020年12月31日广东省人民医院新生儿重...目的比较早产儿和足月儿持续性肺动脉高压(persistent pulmonary hypertension of the newborn,PPHN)发病的高危因素及预后,以指导PPHN的防治。方法本研究为单中心回顾性研究,收集2010年1月1日至2020年12月31日广东省人民医院新生儿重症监护室收治的161例PPHN新生儿的资料,根据胎龄分为早产儿组和足月儿组,比较两组患儿PPHN发生的危险因素及预后。结果PPHN患儿总体病死率为18.0%(29/161),早产儿组与足月儿组病死率分别为22.7%(17/75)和14.0%(12/86),两组病死率比较差异无统计学意义(P=0.151)。男性、剖宫产增加PPHN发生的风险。早产儿PPHN的原发病以新生儿呼吸窘迫综合征最常见,其宫内感染、胎膜早破、孕期感染、双胎和窒息复苏比例显著高于足月儿,差异有统计学意义(P<0.05)。足月儿PPHN的原发病以肺炎最常见,其胎粪吸入综合征和败血症的患儿比例显著高于早产儿,差异有统计学意义(P<0.05)。合并先天性膈疝或先天性肺发育异常的患儿病死率最高。早产患儿比足月患儿更易出现脑室内出血等神经系统并发症,差异有统计学意义(P<0.05)。结论PPHN多发生于男性和剖宫产娩出的患儿,新生儿呼吸窘迫综合征是早产儿PPHN最常见的病因,肺炎是足月儿PPHN最常见的病因,早产患儿比足月患儿预后差。展开更多
Background The cardiovascular characteristics during septic shock in premature neonates are characterized by elevated ventricular output and normal ejection fraction.However,there is little knowledge about other varia...Background The cardiovascular characteristics during septic shock in premature neonates are characterized by elevated ventricular output and normal ejection fraction.However,there is little knowledge about other variables in premature infants with Klebsiella Pneumoniae(KPN)septicemia and shock.This study aimed to investigate the characteristics of cardiovascular changes in premature infants diagnosed with Klebsiella pneumonia(KPN)septicemia and shock.Methods Our study included premature infants(gestational age≤34 weeks)in the neonatal intensive care unit(NICU)of Guangdong Provincial People.s Hospital from November 1 st,2013 to November 31 st,2016.17 participants diagnosed with KPN septicemia complicated with shock and 17 healthy premature infants were respectively enrolled in study group and control group for analysis.All the infants underwent non-invasive ultrasound cardiac output monitor examinations in normal time,early stage of shock and cured time.Results Compared with the control group,higher values of heart rate(HR)(P<0.001),cardiac output index(CI)(P<0.001),Smith-Madigan inotropy index(SMII)(P<0.001)and oxygen delivery(DO2)(P<0.001),and lower levels of systemic vascular resistance index(SVRI)(P<0.001)were observed in the study group.The difference of mean blood pressure(MBP)was not statistically significant(P=0.943).In the study group,the values of HR(P=0.004),CI(P=0.004),SMII(P=0.004)and DO2(P=0.004)in the early stage of septic shock were significantly higher when compared with the values in the normal time,while the value of SVRI(P<0.001)was significantly lower.HR(P<0.001)and DO2(P=0.009)decreased from the early stage of septic shock to the cured time,while SVRI(P<0.001)increased.There were no significant changes in CI(P>0.999)and SMII(P=0.646)from early stage of septic shock to improvement in the study group.Conclusions Systemic vascular resistance index decreased and oxygen deliver elevated in preterm infants with gestational age less than 34 weeks with Klebsiella Pneumoniae septicemia and shock.Vasoregulatory failure may be the main cause of Klebsiella Pneumoniae septicemia and shock.Vasoactive drugs may be needed during shock.The increase of oxygen deliver level in the early stage of shock indicates that timely and effective vasoactive infusion can prevent the deterioration of the disease.展开更多
Cardiovascular variables,including stroke volume index,cardiac output index,Smith-Madigan inotropy index and systemic vascular resistance index,are common indexes to monitor critical patients in intensive care unit(IC...Cardiovascular variables,including stroke volume index,cardiac output index,Smith-Madigan inotropy index and systemic vascular resistance index,are common indexes to monitor critical patients in intensive care unit(ICU).A decrease in CO>50%compared with the initial measurement is associated with mortality in preterm neonates with sepsis.But the diagnostic value of these indexes on infected premature infants were less understood before.This study was aimed to evaluate the diagnostic values on infection of premature infants.Methods This was a prospective observational study that included 22 early preterm neonates with proven infection and 16 controls with possible infection.These preterm infants were admitted to neonatal intensive care unit(NICU)from November 2015 to December 2016.Stroke volume index,cardiac output index,Smith-Madigan inotropy index and systemic vascular resistance index were measured both in healthy time and early stage of proven or possible infection.Clinical characteristics and laboratory data were collected.Results Compared with controls,the change of stroke volume index(△SVI)(P=0.001,95%CI:-2.506 to-0.691),the change of cardiac output index(△CI)(P<0.001,95%CI:-0.537 to-0.202),the change of Smith-Madigan inotropy index(△SMII)(P=0.002,95%CI:-0.113 to-0.027)and the change of systemic vascular resistance index(△SVRI)(P=0.002,95%CI:61.186 to 264.756)were more obvious among preterm infants with infection.△CI had an area under the receiver operating characteristic(ROC)curve of 0.722(P<0.001,95%CI:0.628 to 0.816)for differentiating infected infants from controls.Above a cutoff level of 0.313 L/(min·m^(-2)),△CI had a sensitivity of 66.7%and a specificity of 77.1%.The participants were divided into high△CI group[>0.313 L/(min·m^(-2))]and normal△CI group[≤0.313 L/(min·m^(-2))]according to the cut-off value.Compared with the normal△CI level group,higher stroke volume index(P<0.001,95%CI:1.647 to 3.294),Smith-Madigan inotropy index(P<0.001,95%CI:0.025 to0.110)as well as lower levels of systemic vascular resistance index(P=0.002,95%CI:-396.834 to-221.444)were observed in the high△CI group.Binary logistic regression demonstrated that premature patients with higher increase of CI were associated with the infection(OR:3.080,P=0.026).Conclusions CI,SVI,SVRI and SMII changed obviously in the preterm infants of less than 34 weeks gestation with infection.The increased CI was associated with the infection of preterm patients.CI was expected to be an independent prognostic predictor of infection for preterm infants.展开更多
文摘目的比较早产儿和足月儿持续性肺动脉高压(persistent pulmonary hypertension of the newborn,PPHN)发病的高危因素及预后,以指导PPHN的防治。方法本研究为单中心回顾性研究,收集2010年1月1日至2020年12月31日广东省人民医院新生儿重症监护室收治的161例PPHN新生儿的资料,根据胎龄分为早产儿组和足月儿组,比较两组患儿PPHN发生的危险因素及预后。结果PPHN患儿总体病死率为18.0%(29/161),早产儿组与足月儿组病死率分别为22.7%(17/75)和14.0%(12/86),两组病死率比较差异无统计学意义(P=0.151)。男性、剖宫产增加PPHN发生的风险。早产儿PPHN的原发病以新生儿呼吸窘迫综合征最常见,其宫内感染、胎膜早破、孕期感染、双胎和窒息复苏比例显著高于足月儿,差异有统计学意义(P<0.05)。足月儿PPHN的原发病以肺炎最常见,其胎粪吸入综合征和败血症的患儿比例显著高于早产儿,差异有统计学意义(P<0.05)。合并先天性膈疝或先天性肺发育异常的患儿病死率最高。早产患儿比足月患儿更易出现脑室内出血等神经系统并发症,差异有统计学意义(P<0.05)。结论PPHN多发生于男性和剖宫产娩出的患儿,新生儿呼吸窘迫综合征是早产儿PPHN最常见的病因,肺炎是足月儿PPHN最常见的病因,早产患儿比足月患儿预后差。
基金supported by National key Program(No.2018 YFC1002600)Guangdong Medical Research Foundation(No.A2016177)。
文摘Background The cardiovascular characteristics during septic shock in premature neonates are characterized by elevated ventricular output and normal ejection fraction.However,there is little knowledge about other variables in premature infants with Klebsiella Pneumoniae(KPN)septicemia and shock.This study aimed to investigate the characteristics of cardiovascular changes in premature infants diagnosed with Klebsiella pneumonia(KPN)septicemia and shock.Methods Our study included premature infants(gestational age≤34 weeks)in the neonatal intensive care unit(NICU)of Guangdong Provincial People.s Hospital from November 1 st,2013 to November 31 st,2016.17 participants diagnosed with KPN septicemia complicated with shock and 17 healthy premature infants were respectively enrolled in study group and control group for analysis.All the infants underwent non-invasive ultrasound cardiac output monitor examinations in normal time,early stage of shock and cured time.Results Compared with the control group,higher values of heart rate(HR)(P<0.001),cardiac output index(CI)(P<0.001),Smith-Madigan inotropy index(SMII)(P<0.001)and oxygen delivery(DO2)(P<0.001),and lower levels of systemic vascular resistance index(SVRI)(P<0.001)were observed in the study group.The difference of mean blood pressure(MBP)was not statistically significant(P=0.943).In the study group,the values of HR(P=0.004),CI(P=0.004),SMII(P=0.004)and DO2(P=0.004)in the early stage of septic shock were significantly higher when compared with the values in the normal time,while the value of SVRI(P<0.001)was significantly lower.HR(P<0.001)and DO2(P=0.009)decreased from the early stage of septic shock to the cured time,while SVRI(P<0.001)increased.There were no significant changes in CI(P>0.999)and SMII(P=0.646)from early stage of septic shock to improvement in the study group.Conclusions Systemic vascular resistance index decreased and oxygen deliver elevated in preterm infants with gestational age less than 34 weeks with Klebsiella Pneumoniae septicemia and shock.Vasoregulatory failure may be the main cause of Klebsiella Pneumoniae septicemia and shock.Vasoactive drugs may be needed during shock.The increase of oxygen deliver level in the early stage of shock indicates that timely and effective vasoactive infusion can prevent the deterioration of the disease.
基金supported by National key Program(No.2018YFC1002600)Guangdong Medical Research Foundation(No.A2016177)Guangdong Natural Science Foundation(No.2016A030313793)。
文摘Cardiovascular variables,including stroke volume index,cardiac output index,Smith-Madigan inotropy index and systemic vascular resistance index,are common indexes to monitor critical patients in intensive care unit(ICU).A decrease in CO>50%compared with the initial measurement is associated with mortality in preterm neonates with sepsis.But the diagnostic value of these indexes on infected premature infants were less understood before.This study was aimed to evaluate the diagnostic values on infection of premature infants.Methods This was a prospective observational study that included 22 early preterm neonates with proven infection and 16 controls with possible infection.These preterm infants were admitted to neonatal intensive care unit(NICU)from November 2015 to December 2016.Stroke volume index,cardiac output index,Smith-Madigan inotropy index and systemic vascular resistance index were measured both in healthy time and early stage of proven or possible infection.Clinical characteristics and laboratory data were collected.Results Compared with controls,the change of stroke volume index(△SVI)(P=0.001,95%CI:-2.506 to-0.691),the change of cardiac output index(△CI)(P<0.001,95%CI:-0.537 to-0.202),the change of Smith-Madigan inotropy index(△SMII)(P=0.002,95%CI:-0.113 to-0.027)and the change of systemic vascular resistance index(△SVRI)(P=0.002,95%CI:61.186 to 264.756)were more obvious among preterm infants with infection.△CI had an area under the receiver operating characteristic(ROC)curve of 0.722(P<0.001,95%CI:0.628 to 0.816)for differentiating infected infants from controls.Above a cutoff level of 0.313 L/(min·m^(-2)),△CI had a sensitivity of 66.7%and a specificity of 77.1%.The participants were divided into high△CI group[>0.313 L/(min·m^(-2))]and normal△CI group[≤0.313 L/(min·m^(-2))]according to the cut-off value.Compared with the normal△CI level group,higher stroke volume index(P<0.001,95%CI:1.647 to 3.294),Smith-Madigan inotropy index(P<0.001,95%CI:0.025 to0.110)as well as lower levels of systemic vascular resistance index(P=0.002,95%CI:-396.834 to-221.444)were observed in the high△CI group.Binary logistic regression demonstrated that premature patients with higher increase of CI were associated with the infection(OR:3.080,P=0.026).Conclusions CI,SVI,SVRI and SMII changed obviously in the preterm infants of less than 34 weeks gestation with infection.The increased CI was associated with the infection of preterm patients.CI was expected to be an independent prognostic predictor of infection for preterm infants.
