新生儿重症监护病房中接受氧疗的新生儿的脉搏血氧饱和度水平和动脉血氧张力值：85%至93%是可接受范围吗？

Pulse oxygen saturation levels and arterial oxygen tension values in newborns receiving oxygen therapy in the neonatal intensive care unit: is 85% to 93% an acceptable range?

作者信息

Castillo Armando, Sola Augusto, Baquero Hernando, Neira Freddy, Alvis Ramiro, Deulofeut Richard, Critz Ann

机构信息

Division of Neonatal-Perinatal Medicine, Emory University, Atlanta, Georgia, USA.

出版信息

Pediatrics. 2008 May;121(5):882-9. doi: 10.1542/peds.2007-0117.

DOI:10.1542/peds.2007-0117

PMID:18450890

Abstract

OBJECTIVE

Our aim was to define the relationship of PaO(2) and pulse oxygen saturation values during routine clinical practice and to evaluate whether pulse oxygen saturation values between 85% and 93% were associated with PaO(2) levels of <40 mmHg.

METHODS

Prospective comparison of PaO(2) and pulse oxygen saturation values in 7 NICUs at sea level in 2 countries was performed. The PaO(2) measurements were obtained from indwelling arterial catheters; simultaneous pulse oxygen saturation values were recorded if the pulse oxygen saturation values changed <1% before, during, and after the arterial gas sample was obtained.

RESULTS

We evaluated 976 paired PaO(2)/pulse oxygen saturation values in 122 neonates. Of the 976 samples, 176 (18%) from infants breathing room air had a mean pulse oxygen saturation of 93.9 +/- 4.3% and a median of 95.5%. The analysis of 800 samples from infants breathing supplemental oxygen revealed that, when pulse oxygen saturation values were 85% to 93%, the mean PaO(2) was 56 +/- 14.7 mmHg and the median 54 mmHg. At this pulse oxygen saturation level, 86.8% of the samples had PaO(2) values of 40 to 80 mmHg, 8.6% had values of <40 mmHg, and 4.6% had values of >80 mmHg. When the pulse oxygen saturation values were >93%, the mean PaO(2) was 107.3 +/- 59.3 mmHg and the median 91 mmHg. At this pulse oxygen saturation level, 39.5% of the samples had PaO(2) values of 40 to 80 mmHg and 59.5% had values of >80 mmHg.

CONCLUSIONS

High PaO(2) occurs very rarely in neonates breathing supplemental oxygen when their pulse oxygen saturation values are 85% to 93%. This pulse oxygen saturation range also is infrequently associated with low PaO(2) values. Pulse oxygen saturation values of >93% are frequently associated with PaO(2) values of >80 mmHg, which may be of risk for some newborns receiving supplemental oxygen.

摘要

目的

我们的目的是确定常规临床实践中动脉血氧分压（PaO₂）与脉搏血氧饱和度值之间的关系，并评估脉搏血氧饱和度值在85%至93%之间是否与PaO₂水平<40 mmHg相关。

方法

对2个国家海平面上7个新生儿重症监护病房（NICU）的PaO₂和脉搏血氧饱和度值进行前瞻性比较。PaO₂测量值通过留置动脉导管获得；如果在采集动脉血气样本之前、期间和之后脉搏血氧饱和度值变化<1%，则记录同时的脉搏血氧饱和度值。

结果

我们评估了122例新生儿的976对PaO₂/脉搏血氧饱和度值。在976个样本中，176个（18%）来自呼吸空气的婴儿，其平均脉搏血氧饱和度为93.9±4.3%，中位数为95.5%。对800个来自呼吸补充氧气婴儿的样本分析显示，当脉搏血氧饱和度值为85%至93%时，平均PaO₂为56±14.7 mmHg，中位数为54 mmHg。在此脉搏血氧饱和度水平下，86.8%的样本PaO₂值为40至80 mmHg，8.6%的值<40 mmHg，4.6%的值>80 mmHg。当脉搏血氧饱和度值>93%时，平均PaO₂为107.3±59.3 mmHg，中位数为91 mmHg。在此脉搏血氧饱和度水平下，39.5%的样本PaO₂值为40至80 mmHg，59.5%的值>80 mmHg。