Gomez-Pomar Enrique, Makhoul Majd, Westgate Philip M, Ibonia Katrina T, Patwardhan Abhijit, Giannone Peter J, Bada Henrietta S, Abu Jawdeh Elie G
Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, Kentucky.
Division of Cardiology, Department of Pediatrics, University of Kentucky, Lexington, Kentucky.
Pediatr Res. 2017 May;81(5):775-779. doi: 10.1038/pr.2017.10. Epub 2017 Jan 18.
Perfusion index (PI) is a noninvasive measure of perfusion. ΔPI (difference between pre- and postductal PI) may identify hemodynamically significant PDA. However, studies are limited to brief and intermittent ΔPI sampling. Our objective is to assess the value of continuous high resolution ΔPI monitoring in the diagnosis of PDA.
Continuous ΔPI monitoring in preterm infants was prospectively performed using two high-resolution pulse oximeters. Perfusion Index measures (ΔPI mean and variability, pre- and postductal PI) were analyzed over a 4-h period prior to echocardiography. A cardiologist blinded to the results evaluated for PDA on echocardiography. Linear mixed regression models were utilized for analyses.
We obtained 31 echocardiography observations. Mean ΔPI (-0.23 vs. 0.16; P < 0.05), mean pre-PI (0.86 vs. 1.26; P < 0.05), and ΔPI variability (0.39 vs. 0.61; P = 0.05) were lower in infants with PDA compared to infants without PDA at the time of echocardiography.
Mean ΔPI, ΔPI variability, and mean pre-PI measured 4 h prior to echocardiography detect PDA in preterm infants. PI is dynamic and should be assessed continuously. Perfusion index is a promising bedside measurement to identify PDA in preterm infants.
灌注指数（PI）是一种无创的灌注测量指标。ΔPI（导管前和导管后PI之间的差值）可能有助于识别具有血流动力学意义的动脉导管未闭（PDA）。然而，相关研究仅限于短暂和间歇性的ΔPI采样。我们的目的是评估连续高分辨率ΔPI监测在PDA诊断中的价值。
使用两台高分辨率脉搏血氧仪对早产儿进行连续ΔPI监测。在超声心动图检查前4小时内分析灌注指数测量值（ΔPI平均值和变异性、导管前和导管后PI）。一位对结果不知情的心脏病专家对超声心动图上的PDA进行评估。采用线性混合回归模型进行分析。
我们获得了31次超声心动图检查结果。在超声心动图检查时，与无PDA的婴儿相比，有PDA的婴儿的平均ΔPI（-0.23对0.16；P<0.05）、平均导管前PI（0.86对1.26；P<0.05）和ΔPI变异性（0.39对0.61；P=0.05）较低。
在超声心动图检查前4小时测量的平均ΔPI、ΔPI变异性和平均导管前PI可检测早产儿的PDA。PI是动态的，应进行连续评估。灌注指数是一种很有前景的用于识别早产儿PDA的床旁测量指标。
