早产儿机械通气常频模式对无创灌注指数的影响及其临床意义

doi:10.13481/j.1671-587X.20240225

Abstract

Abstract:

Objective To compare the differences in noninvasive perfusion index （PI） before and after extubation between the right palm （ preductal） and right sole （postductal） in the preterm infants，and to discuss whether the conventional frequency mechanical ventilation （MV） mode has an effect on it， and to clarify the correlation between the respiratory severity score （RSS） and PI. Methods The preterm infants with the gestational age （GA） ≥32 weeks and body weight （BW） ≥1 500 g who were born with respiratory distress and underwent noninvasive assisted ventilation therapy， with pulse oxygen saturation （SpO₂） <90%， requiring conventional frequency MV assistance， were selected. A total of 55 patients met the inclusion criteria were included. The extubation was carried out after meeting the criteria 24 h after birth. The median values within 30 s after stabilization of PI in the right palm and right sole were recorded before and after extubation. At the same time， the ventilator parameters such as the fraction of inspired oxygen （FiO₂） and the mean airway pressure （P_mean） before extubation were recorded. The paired samples t-test was used to compare the differences in PI of the right palm and right sole before and after extubation；multivariate linear regression analysis was used to analyze the correlation between GA， BW， and RSS with the preductal PI of the right palm before extubation and the correlation between FiO₂ and P_mean with PI. Results The PI of the right palm before extubation was lower than after extubation （P<0.05）； the PI of the right sole before extubation was lower than that after extubation （P<0.05）； the linear regression analysis results showed there was no correlation between GA and PI （P>0.05）， there was a positive correlation between BW and PI ［b=0.44，standardized regression coefficient （β）=0.25， P<0.05）］， and there was a negative correlation between RSS and PI （b=－0.56， β=－0.68， P<0.05）， and the regression equation was PI=1.9+0.44×BW－0.56×RSS；the further multivariate linear regression analysis results of the ventilator parameters showed that the ventilator parameters constituting the RSS， FiO₂ （b=－2.52， β=－0.27， P<0.05） and P_mean （b=－0.39， β=－0.63， P<0.05）， both showed a linear relationship with PI and they were risk factors for it， and the β value of P_mean was greater than that of FiO₂， indicating that the former had a greater impact on PI. Conclusion The conventional frequency MV mode can affect PI， and RSS under this mode is a risk factor for PI； higher RSS can have an adverse effect on the circulation， and P_mean has a greater impact on PI compared with FiO₂.

Key words: Perfusion index, Mechanical ventilation, Premature infant, Mean airway pressure, Fraction of inspiration O₂, Respiratory severity score, Gestational age, Birth weight

CLC Number:

R722.6

Xiaoqi ZHAO,Jing LI,Xin WANG. Effect of conventional mechanical ventilation on noninvasive perfusion index in preterm infants and its clinical significance[J].Journal of Jilin University(Medicine Edition), 2024, 50(2): 508-514.

Figures/Tables 5

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References 40

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Part	PI		Difference of PI	t	P
Part	Before weaning	After weaning	Difference of PI	t	P
Right palm	1.73±0.65	2.10±0.65^*	－0.37±0.42	－6.35	<0.05
Right foot	1.67±0.62	1.99±0.72^*	－0.32±0.38	－6.35	<0.05
^*P<0.05 vs before weaning.

Variable	b	Standard error	β	t	P
Constant	1.90	1.73	－	1.10	0.28
GA	0.01	0.06	0.01	0.14	0.89
BW	0.44	0.18	0.25	2.40	0.02
RSS	－0.56	0.07	－0.68	－7.71	<0.01

Variable	b	Standard error	β	t	P
Constant	5.49	0.37	－	14.78	<0.01
FiO₂	－2.52	0.94	－0.27	－2.69	0.01
Pmean	－0.39	0.06	－0.63	－6.33	<0.01

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Effect of conventional mechanical ventilation on noninvasive perfusion index in preterm infants and its clinical significance

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