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目的:对早产儿动脉二氧化碳分压(PaCO_2)极值及差值与严重脑室内出血的关系进行探究,以期寻求早产儿PaCO_2的安全范围。方法:收集2010年1月—2013年1月在南京医科大学附属儿童医院NICU住院的152例早产儿资料,判断PaCO_2与颅内出血的关系。结果:(1)152例早产儿中,严重脑室内出血组54例,无严重脑室内出血组98例。(2)严重脑室内出血患儿较非严重脑室内出血者,PaCO_2峰值更大(65.00 mm Hg vs.52.00 mm Hg)、差值更大(35.60 mm Hg vs.16.35 mm Hg),而PaCO_2谷值更小(30.30 mm Hg vs.36.00 mm Hg),P均<0.05。(3)与没有使用通气支持的患儿相比,应用机械通气(MV)或持续正压气道通气(CPAP)模式的患儿PaCO_2的波动范围更大。(4)ROC分析示PaCO_2在31.60~62.00 mm Hg范围内的患儿(n=85,55.92%),严重脑室内出血发生率仅为15.29%。(5)Logistic回归分析显示:影响早产儿严重脑室内出血的独立危险因素为PaCO_2峰值>62.20 mm Hg、PaCO_2谷值<31.60mm Hg及PaCO_2差值>26.15 mm Hg(OR值分别为3.25、2.15和3.31,P均<0.05)。结论:早产儿由于自身脑发育及脑血流调节的特点,动态监测PaCO_2、界定PaCO_2的“安全”范围显得尤为重要。
OBJECTIVE: To explore the relationship between the extreme value of arterial CO2 partial pressure (PaCO2) and severe intraventricular hemorrhage in preterm infants to explore the safe range of PaCO2 in preterm infants. Methods: Data of 152 premature infants hospitalized at NICU of Nanjing Medical University from January 2010 to January 2013 were collected to determine the relationship between PaCO_2 and intracranial hemorrhage. Results: (1) Among 152 preterm infants, 54 cases had severe intraventricular hemorrhage and 98 cases had no severe intracerebral hemorrhage. (2) In patients with severe intraventricular hemorrhage, PaCO_2 had a larger peak (65.00 mm Hg vs.52.00 mm Hg) and a greater difference (35.60 mm Hg vs.16.35 mm Hg) than non-severe intraventricular hemorrhage Small (30.30 mm Hg vs. 36.00 mm Hg), P <0.05. (3) PaCO 2 in children with mechanical ventilation (MV) or continuous positive airway pressure (CPAP) patterns was more fluctuating than children without ventilatory support. (4) The ROC analysis showed that the incidence of severe intraventricular hemorrhage was 15.29% in patients with PaCO_2 in the range of 31.60-62.00 mm Hg (n = 85,55.92%). (5) Logistic regression analysis showed that the independent risk factors of severe intraventricular hemorrhage in preterm infants were PaCO 2 peak value> 62.20 mm Hg, PaCO_2 trough value <31.60 mm Hg and PaCO_2 difference value> 26.15 mm Hg (OR values: 3.25, 2.15 and 3.31, P <0.05). Conclusion: Due to the characteristics of self brain development and cerebral blood flow regulation in preterm infants, the dynamic monitoring of PaCO_2 and defining the “safe” range of PaCO_2 are particularly important.