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目的探讨有创血压监测在足月新生儿重症监护中的应用价值。方法选取2010—2012年本院新生儿重症监护室行有创血压监测的足月儿新生儿,包括窒息、缺氧缺血脑病、败血症、新生儿出血症、手术后、休克及新生儿溶血病等,患儿均建立有创血压监测系统,并分别在有创血压监测同时进行无创血压监测,比较两者的相关性。结果研究期间共60例重症足月儿行有创血压监测,患儿第一次测量日龄(7.2±1.9)h,收缩压(62.4±11.7)mmHg,同期无创血压收缩压为(58.2±10.5)mmHg,差异有统计学意义(P<0.05),两种监测方式的舒张压和平均动脉压差异无统计学意义(P>0.05)。出生窒息、缺氧缺血性脑病、出血性疾病、新生儿休克及新生儿溶血病可以明显影响有创收缩压值,其β值及β值的95%可信区间分别为2.14(1.10～3.47)、3.11(1.17～4.47)、3.45(1.34～5.77)、4.55(2.34～7.89)和3.25(1.78～5.57)。而无创收缩压仅受新生儿休克状况影响,β值及其95%可信区间为3.45(1.98～5.77)。结论对于危重症足月儿,尤其是存在血流动力学不稳定的患儿,在条件允许情况下应在新生儿重症监护室积极进行有创血压监测。
Objective To investigate the value of invasive blood pressure monitoring in term neonatal intensive care. Methods From 2010 to 2012 in our hospital neonatal intensive care unit with invasive blood pressure monitoring of full-term newborn infants, including asphyxia, hypoxic-ischemic encephalopathy, sepsis, neonatal hemorrhagic disease, surgery, shock and neonatal hemolytic disease Etc. In children, an invasive blood pressure monitoring system was established. Noninvasive blood pressure monitoring was performed at the same time as invasive blood pressure monitoring, and the correlation between the two was compared. Results During the study period, a total of 60 severely ill term children underwent invasive blood pressure monitoring. The first measurement of children’s age was (7.2 ± 1.9) h, systolic blood pressure (62.4 ± 11.7) mmHg, systolic blood pressure (58.2 ± 10.5 ) mmHg, the difference was statistically significant (P <0.05). There was no significant difference in diastolic blood pressure and mean arterial pressure between the two monitoring methods (P> 0.05). Birth asphyxia, hypoxic-ischemic encephalopathy, hemorrhagic disease, neonatal shock and neonatal hemolytic disease can significantly affect the value of invasive systolic blood pressure, 95% confidence interval of β and β values were 2.14 (1.10 ~ 3.47 ), 3.11 (1.17 ~ 4.47), 3.45 (1.34 ~ 5.77), 4.55 (2.34 ~ 7.89) and 3.25 (1.78 ~ 5.57). Noninvasive systolic blood pressure was only affected by neonatal shock status. The β value and its 95% confidence interval were 3.45 (1.98-5.77). Conclusions For critically ill full-term infants, especially those with hemodynamically unstable conditions, invasive blood pressure monitoring should be actively performed in the neonatal intensive care unit when conditions permit.