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JAMA子刊:使用“家用脉搏血氧仪”监测支气管肺发育不良婴儿的警报负担

2022-06-25 liangying MedSci原创

扩大SpO2限值和/或增加报警延迟可显著降低报警率,同时保留潜在严重低氧血症发作的报警。

大约一半的极早产儿患有支气管肺发育不良(BPD)。这些婴儿中有四分之一需要家庭供氧,但家庭脉搏血氧饱和度测定的依从性很低。在BPD患者中,家庭血氧计警报的真实负担以及报警参数对警报发生率的影响尚不清楚。本研究的目的是通过模拟阈值调整,利用BPD婴儿连续家庭SpO2监测临床试验的数据,评估低血氧饱和度(SpO2)限值、警报延迟的平均时间与警报发生率的关系。

BPD饱和靶向试验是一项正在进行的随机临床试验(NCT03385330),在该试验中,中度或重度BPD的早产儿在经后34 ~ 44周龄(PMA)至校正6月龄睡眠时接受SpO2监测(Masimo Rad-8)。在这项二级研究中,研究者使用了出院后前4周内获得的家庭血氧仪数据。包括8小时或以上可用数据的患者。本研究使用的原始数据估计SpO2限值为80%、85%和90%时发生的低SpO2报警计数,报警延迟0、5、10和15秒,平均时间为8秒和16秒。

研究最后纳入了20名平均(SD)出院PMA为47.4(5.2)周的婴儿。在出院后典型的血氧仪设置下,患者每8小时会经历23.1(16.0-53.0)次警报的中值(IQR),平均报警次数少于1次,SpO2限值为80%,延迟15秒,平均时间为8秒或16秒。在每个延迟内,较低的SpoO2限值与8秒和16秒平均时间的较低的报警率相关(P<0.001)。在给定的SpO2限值范围内,较长的报警延迟与较低的报警率相关。在0秒延迟和90%SpO2限值的情况下,8秒和16秒平均时间之间每8小时的警报没有显著差异。

低氧饱和度(SpO2)警报跨越各种饱和阈值和警报延迟

目前的科学表明,SpO2低于80%的间歇性低氧血症发作与恢复期极早产儿发育不良相关。扩大SpO2限值和/或增加报警延迟可显著降低报警率,同时保留潜在严重低氧血症发作的报警。典型的家庭血氧计设置(90%限值,0-s延迟)似乎会给护理人员带来无法承受的报警负担。未来的研究需要评估放宽家庭参数以降低报警率的结果,减少护理者的报警疲劳同时改善家庭监测的依从性。

参考文献:Herrick HM, Passarella M, Weimer J, Bonafide CP, DeMauro SB. Alarm Burden in Infants With Bronchopulmonary Dysplasia Monitored With Pulse Oximetry at Home. JAMA Netw Open. 2022;5(6):e2218367. doi:10.1001/jamanetworkopen.2022.18367.

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    2022-06-27 neurowu
  4. 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26 08:11:40 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228688, encodeId=44391228688ff, content=不错的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0825417521, createdName=ms6000000960504356, createdTime=Sun Jun 26 08:11:32 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228639, encodeId=fef012286399a, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Jun 25 19:44:28 CST 2022, time=2022-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243576, encodeId=538912435e68d, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Sat Jun 25 12:18:17 CST 2022, time=2022-06-25, status=1, ipAttribution=)]
  5. 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26 08:11:40 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228688, encodeId=44391228688ff, content=不错的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0825417521, createdName=ms6000000960504356, createdTime=Sun Jun 26 08:11:32 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228639, encodeId=fef012286399a, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Jun 25 19:44:28 CST 2022, time=2022-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243576, encodeId=538912435e68d, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Sat Jun 25 12:18:17 CST 2022, time=2022-06-25, status=1, ipAttribution=)]
  6. 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26 08:11:40 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228688, encodeId=44391228688ff, content=不错的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0825417521, createdName=ms6000000960504356, createdTime=Sun Jun 26 08:11:32 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228639, encodeId=fef012286399a, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Jun 25 19:44:28 CST 2022, 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  7. 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26 08:11:40 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228688, encodeId=44391228688ff, content=不错的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0825417521, createdName=ms6000000960504356, createdTime=Sun Jun 26 08:11:32 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228639, encodeId=fef012286399a, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Jun 25 19:44:28 CST 2022, time=2022-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243576, encodeId=538912435e68d, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Sat Jun 25 12:18:17 CST 2022, time=2022-06-25, status=1, ipAttribution=)]
  8. 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26 08:11:40 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228688, encodeId=44391228688ff, content=不错的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0825417521, createdName=ms6000000960504356, createdTime=Sun Jun 26 08:11:32 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228639, encodeId=fef012286399a, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Jun 25 19:44:28 CST 2022, time=2022-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243576, encodeId=538912435e68d, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Sat Jun 25 12:18:17 CST 2022, time=2022-06-25, status=1, ipAttribution=)]
    2022-06-26 ms6000000960504356

    不错的文章

    0

  9. 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26 08:11:40 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228688, encodeId=44391228688ff, content=不错的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0825417521, createdName=ms6000000960504356, createdTime=Sun Jun 26 08:11:32 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228639, encodeId=fef012286399a, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Jun 25 19:44:28 CST 2022, time=2022-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243576, encodeId=538912435e68d, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Sat Jun 25 12:18:17 CST 2022, time=2022-06-25, status=1, ipAttribution=)]
    2022-06-25 医鸣惊人

    认真学习了

    0

  10. 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26 08:11:40 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228688, encodeId=44391228688ff, content=不错的文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b0825417521, createdName=ms6000000960504356, createdTime=Sun Jun 26 08:11:32 CST 2022, time=2022-06-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1228639, encodeId=fef012286399a, content=认真学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6EF3hKja8nER8RMzxQdria9eCYFhgLTLsDOeqnvIYdeLDz5eP6EnicLuE5gibiawgno4zUA0jAR7Nbtp2llQ9fs3Mk/0, createdBy=278f1986883, createdName=医鸣惊人, createdTime=Sat Jun 25 19:44:28 CST 2022, time=2022-06-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1243576, encodeId=538912435e68d, content=JAMA上文章都是顶级的,谢谢梅斯及时上新, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=肿瘤克星, createdTime=Sat Jun 25 12:18:17 CST 2022, time=2022-06-25, status=1, ipAttribution=)]
    2022-06-25 肿瘤克星

    JAMA上文章都是顶级的,谢谢梅斯及时上新

    0

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对于需接受持续气道正压治疗的呼吸窘迫综合征早产儿(孕25-28周),微创表面活性物质治疗不能降低36周月龄时死亡或支气管肺发育不良风险。

NEJM:出生后2周开始氢化可的松治疗对改善早产儿无中重度支气管肺发育不良生存率效果不显著

对于存在支气管肺发育不良的早产儿,从出生后第14至28天开始的氢化可的松治疗不能改善无中重度支气管肺发育不良生存率,组间2年的神经发育结果也没有显著差异

CDSR:吸入性糖皮质激素在预防极低出生体重早产儿支气管肺发育不良中的作用

支气管肺发育不良(BPD)仍然是早产儿死亡和发病的重要原因,炎症在其发病机制中起重要作用。吸入性激素的使用可以调节炎症,而不会导致全身激素用药浓度增高和较低的不良反应风险。

基于支气管肺发育不良设计的高氧早产兔模型中肺的立体学

支气管肺发育不良(BPD)是一种与早产相关的慢性人类肺部疾病。在早期,BPD 被描述为呼吸窘迫综合征和治疗干预措施(包括通气和氧气供应)的综合作用的结果。

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