摘要
目的探讨采用无创脑水肿动态监护仪主要输出参数:扰动系数(DC),在高原地区重度窒息新生儿脑水肿中的临床应用价值。方法选择2019年12月至2023年6月于西藏自治区昌都市人民医院新生儿重症监护病房(NICU)治疗的22例高原地区重度窒息新生儿为研究对象,纳入重度窒息组。将同期在同一家医院新生儿病房治疗的22例高原地区非重症新生儿作为对照,纳入对照组。采用前瞻性研究方法,对2组新生儿采用无创脑水肿动态监护仪进行脑水肿监测。采用多因素非条件logistic回归分析法,确定DC值是否为高原地区重度窒息新生儿发生脑水肿的独立影响因素;采用受试者工作特征(ROC)曲线的曲线下面积(AUC),评估DC值对重度窒息新生儿发生脑水肿的评估价值。本研究经昌都市人民医院医学伦理委员会批准(审批文号:2021006)。所有患儿监护人对诊疗过程知情同意,并签署临床研究知情同意书。结果①重度窒息组新生儿DC值为32±11,低于对照组的56±13,并且差异有统计学意义(t=-6.82、P<0.001)。②多因素非条件logistic回归分析显示,DC值升高(OR=0.801,95%CI:0.790~0.895,P=0.049)为重度窒息新生儿发生脑水肿的独立保护因素。③无创脑水肿动态监护仪的DC值,评估重度窒息新生儿发生脑水肿的AUC为0.926,敏感度为81.8%,特异度为90.9%,DC最佳临界值为45.5。结论在高原地区,无创脑水肿监测参数DC值,可以辅助评估新生儿脑水肿,从而及时采取治疗措施。
Objective To explore the clinical application value of the main output parameter of non-invasive dynamic brain edema monitor:disturbance coefficient(DC)in the brain edema of neonates with severe asphyxia in plateau area.Methods From December 2019 to June 2023,22 neonates with severe asphyxia in plateau area treated in neonatal intensive care unit(NICU)of Changdu People′s Hospital in Tibet Autonomous Region were selected as the research objects and included in the severe asphyxia group.Twenty-two cases of non-severe newborns in plateau area who were treated in the neonatal ward of the same hospital in the same period were taken as control group.With prospective research method,non-invasive brain edema dynamic monitoring instrument was used to two groups of neonates for brain edema monitoring.Multivariate unconditional logistic regression analysis was used to determine whether DC value was an independent influencing factor of brain edema in neonates with severe asphyxia in plateau area.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve was used to evaluate the evaluation value of DC value for brain edema in neonates with severe asphyxia.This study was approved by the Medical Ethics Committee of Changdu People′s Hospital(Approval No.2021006).The guardians of all children had informed consents to the diagnosis and treatment process and signed the informed consent forms of clinical research.Results①The DC value of neonates in severe asphyxia group was 32±11,which was lower than that of 56±13 in control group,and the difference was statistically significant(t=-6.82,P<0.001).②Multivariate unconditional logistic regression analysis showed that DC value increase(OR=0.801,95%CI:0.790-0.895,P=0.049)was an independent protective factor for brain edema in neonates with severe asphyxia.③The AUC of the DC value of the non-invasive brain edema dynamic monitor for evaluating brain edema in neonates with severe asphyxia was 0.926,the sensitivity was 81.8%,the specificity was 90.9%,and the o
作者
徐珍娥
杨娅丽
徐晨霞
向巴曲西
王家蓉
Xu Zhene;Yang Yali;Xu Chenxia;Xiang Baquxi;Wang Jiarong(Department of Neonatology,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatrics,Children′s Hospital of Chongqing Medical University,Chongqing 400014,China;Department of Pediatrics,Changdu People′s Hospital,Changdu 854000,Tibet Autonomous Region,China)
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2024年第1期114-119,共6页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
西藏自治区自然科学基金组团式医学援藏项目[XZ2020ZR-ZY71(Z)]。
关键词
窒息
新生儿
脑水肿
颅内压
高海拔
扰动系数
影响因素分析
ROC曲线
婴儿
新生
Asphyxia neonatorum
Brain edema
Intracranial pressure
Altitude
Disturbance coefficient
Root cause analysis
ROC curve
Infant,newborn
