Osborn D A, Evans N, Kluckow M
Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia.
Arch Dis Child Fetal Neonatal Ed. 2004 Mar;89(2):F168-73. doi: 10.1136/adc.2002.023796.
To determine the accuracy of blood pressure (BP), capillary refill time (CRT), and central-peripheral temperature difference (CPTd) for detecting low upper body blood flow in the first day after birth.
A prospective, two centre cohort study of 128 infants born at < 30 weeks gestation. Invasive BP (n = 108), CRT (n = 128), and CPTd (n = 46) were performed immediately before echocardiographic measurement of superior vena cava (SVC) flow at three, 5-10, and 24 hours after birth.
Forty four (34%) infants had low SVC flow (< 41 ml/kg/min) in the first day, 13/122 (11%) at three hours, 39/126 (31%) at 5-10 hours, and 4/119 (3%) at 24 hours. CPTd did not detect infants with low flows. Combining all observations in the first 24 hours, CRT > or = 3 seconds had 55% sensitivity and 81% specificity, mean BP < 30 mm Hg had 59% sensitivity and 77% specificity, and systolic BP < 40 mm Hg had 76% sensitivity and 68% specificity for detecting low SVC flow. Combining a mean BP < 30 mm Hg and/or central CRT > or = 3 seconds increases the sensitivity to 78%.
Low upper body blood flow is common in the first day after birth and strongly associated with peri/intraventricular haemorrhage. BP and CRT are imperfect bedside tests for detecting low blood flow in the first day after birth.
确定出生后第一天测量血压（BP）、毛细血管再充盈时间（CRT）和中心 - 外周温差（CPTd）用于检测上半身低血流量的准确性。
一项针对128例孕周小于30周出生婴儿的前瞻性、双中心队列研究。在出生后3小时、5 - 10小时和24小时，在超声心动图测量上腔静脉（SVC）血流之前立即进行有创血压测量（n = 108）、CRT测量（n = 128）和CPTd测量（n = 46）。
44例（34%）婴儿在出生后第一天出现低SVC血流（< 41 ml/kg/min），3小时时13/122例（11%），5 - 10小时时39/126例（31%），24小时时4/119例（3%）。CPTd未检测出低血流婴儿。综合出生后24小时内的所有观察结果，CRT≥3秒检测低SVC血流的敏感性为55%，特异性为81%；平均血压< 30 mmHg的敏感性为59%，特异性为77%；收缩压< 40 mmHg 的敏感性为76%，特异性为68%。平均血压< 30 mmHg和/或中心CRT≥3秒联合使用可将敏感性提高到78%。
出生后第一天，上半身低血流量很常见，且与脑室周围/脑室内出血密切相关。血压和CRT作为出生后第一天检测低血流量的床边检查并不理想。
