Résumé
Objective To explore the value of percutaneous oxygen partial pressure monitoring in prognosis evaluation of patients with acute heart failure (AHF). Methods A total of 91 patients with AHF due to various reasons admitted to the emergency department of the First Affiliated Hospital of China Medical University from July 2017 to June 2018 were enrolled. Dynamic monitoring data of arterial blood gas, percutaneous oxygen partial pressure monitoring and noninvasive cardiac output monitoring (NICOM) of all of the patients at the time of diagnosis (before treatment) and 6 hours after treatment were recorded, including arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), blood lactic acid (Lac), percutaneous oxygen partial pressure (TcPO2), percutaneous carbon dioxide partial pressure (TcPCO2), cardiac output (CO) and stroke volume (SV). The 10-minute oxygen challenge test value (OCT), oxygen and carbon dioxide offsets were calculated. The patients were divided into survival group and non-survival group according to 28-day survival situation, and the differences in above parameters were compared between the two groups. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of percutaneous partial oxygen pressure monitoring for the prognosis of patients with AHF. Results All the 91 patients were enrolled in the analysis, among whom 26 died on 28 days and 65 survived, with a mortality of 28.6%. Before treatment, 10-minute OCT in the non-survival group was significantly lower than that in the survival group [mmHg (1 mmHg = 0.133 kPa):41.0±3.9 vs. 45.6±3.2, P < 0.01], and the carbon dioxide offset was significantly higher than that in the survival group [(0.51±0.11)% vs. (0.37±0.11)%, P < 0.01]. However, there was no statistically significant difference in PaO2, PaCO2, TcPO2, TcPCO2, oxygen offset, CO, SV or Lac between the two groups. After 6 hours of treatment, TcPCO2, oxygen offset and carbon dioxide offset in the non-survival group were significantly higher than those in the survival group [TcPCO2 (mmHg): 36.0±2.8 vs. 33.2±2.8, oxygen offset: (0.25±0.05)% vs. (0.22±0.06)%, carbon dioxide offset: (0.29±0.12)% vs. (0.16±0.13)%, all P < 0.05], TcPO2, 10-minute OCT, CO and SV were significantly lower than those in the survival group [TcPCO2 (mmHg): 36.0±2.8 vs. 33.2±2.8, 10-minute OCT (mmHg): 49.1±4.5 vs. 53.6±5.5, CO (L/min):4.9±0.5 vs. 5.3±0.5, SV (mL): 57.8±3.5 vs. 64.4±4.8, all P < 0.01]. However, there was no statistically significant difference in PaO2, PaCO2 or Lac between the two groups. ROC curve analysis showed that the area under the ROC curve (AUC) of 10-minute OCT onset predicting the 28-day death of patients with AHF was 0.802; when the optimal cut-off value was 43.5 mmHg, the sensitivity and specificity was 77.3% and 68.0%, respectively. The AUC of carbon dioxide offset was 0.812; when the optimal cut-off value was 0.46%, the sensitivity and specificity was 86.4% and 68.0%, respectively. Conclusions Percutaneous oxygen partial pressure monitoring can be used as a reliable indicator for prognosis evaluation of patients with AHF. Increased carbon dioxide offset and decreased 10-minute OCT suggest poor prognosis, and the prognosis of patients with AHF should be evaluated by dynamic monitoring.
Résumé
Objectives Study on the accuracy and influencing factors of neonatal intensive care unit (NICU) critically ill newborns different body parts monitoring by percutaneous oxygen partial pressure (TcpO2) and carbon dioxide partial pressure (TcpCO2), in order to provide a basis for non-invasive monitoring of critically ill newborns in ICU. Methods 60 cases of critically ill newborns requiring blood gas analysis were selected as research cases during July 2017 to March 2018 in Wuxi City Maternity and Child Hospital Neonatology. According to the randomized control principle, three groups were divided, chest group (20 cases), abdomen group (20 cases), leg group (20 cases). The chest group placed the electrodes of the transcutaneous gas analyzer on newborns′anterior chest. The abdomen group placed the electrodes on newborns′ abdomen. And the leg group placed the electrodes on the inner thigh. PaO2 and PaCO2 values were collected from the blood gas results of critically ill newborns. TcpO2 and TcpCO2 values were recorded. And at the same time, the electrode shedding situation was observed as well. Compare transcutaneous data and arterial blood data, and do analysis. Result The chest group TcpO2(69.05 ± 9.17)mmHg(1 mmHg=0.133 kPa), TcpCO2( 46.9±10.57)mmHg, PaO(276.4±8.64)mmHg, PaCO(240.65± 4.74)mmHg, the PaO2 and PaCO2 values were obviously different from the blood gas analysis results (t=-2.608, 2.413, P<0.05). The abdomen group and the leg group had no significant differences(P>0.05). And the electrode sheet shedding rate was 30% in the chest group, 25% in the abdomen group, and 10% in the leg group, the three groups had no significant differences(χ2=2.553,P>0.05). Conclusion NICU critically ill newborns thigh skin monitoring by percutaneous oxygen partial pressure and carbon dioxide partial pressure has high accuracy, and the electrode sheet shedding rate is relatively low. Therefore, it is a safe and effective clinical monitoring method, of great significance for monitoring changes in the condition of critically ill newborns.
Résumé
Objectives@#Study on the accuracy and influencing factors of neonatal intensive care unit (NICU) critically ill newborns different body parts monitoring by percutaneous oxygen partial pressure (TcpO2) and carbon dioxide partial pressure (TcpCO2), in order to provide a basis for non-invasive monitoring of critically ill newborns in ICU.@*Methods@#60 cases of critically ill newborns requiring blood gas analysis were selected as research cases during July 2017 to March 2018 in Wuxi City Maternity and Child Hospital Neonatology. According to the randomized control principle, three groups were divided, chest group (20 cases), abdomen group (20 cases), leg group (20 cases). The chest group placed the electrodes of the transcutaneous gas analyzer on newborns′ anterior chest. The abdomen group placed the electrodes on newborns′ abdomen. And the leg group placed the electrodes on the inner thigh. PaO2 and PaCO2 values were collected from the blood gas results of critically ill newborns. TcpO2 and TcpCO2 values were recorded. And at the same time, the electrode shedding situation was observed as well. Compare transcutaneous data and arterial blood data, and do analysis.@*Result@#The chest group TcpO2 (69.05±9.17) mmHg(1 mmHg=0.133 kPa), TcpCO2 (46.9±10.57) mmHg, PaO2 (76.4±8.64) mmHg, PaCO2 (40.65±4.74) mmHg, the PaO2 and PaCO2 values were obviously different from the blood gas analysis results (t=-2.608, 2.413, P<0.05). The abdomen group and the leg group had no significant differences (P>0.05) . And the electrode sheet shedding rate was 30% in the chest group, 25% in the abdomen group, and 10% in the leg group, the three groups had no significant differences (χ2=2.553, P>0.05) .@*Conclusion@#NICU critically ill newborns thigh skin monitoring by percutaneous oxygen partial pressure and carbon dioxide partial pressure has high accuracy, and the electrode sheet shedding rate is relatively low. Therefore, it is a safe and effective clinical monitoring method, of great significance for monitoring changes in the condition of critically ill newborns.