脉搏血氧饱和度监测在极早产儿运动中检测低氧血症的可靠性。
Pulse oximetry reliability for detection of hypoxemia under motion in extremely premature infants.
机构信息
Division of Neonatology, Departments of Pediatrics, Miller School of Medicine, Miami, FL, USA.
Biomedical Engineering, College of Engineering, University of Miami, Coral Gables, FL, USA.
出版信息
Pediatr Res. 2023 Jan;93(1):118-124. doi: 10.1038/s41390-022-02258-7. Epub 2022 Aug 17.
BACKGROUND
Episodes of intermittent hypoxemia (IH) in extremely premature infants are detected by pulse oximetry (SpO) but motion artifact can cause falsely low readings.
OBJECTIVES
To evaluate the reliability of SpO during IH episodes associated with motion in premature infants of ≤28 weeks GA monitored with 2 pulse oximeters.
METHODS
IH episodes (defined as SpO < 90%, >10 s and SpO < 80%, >10 s) were classified by an analytic tool based on distortion caused by motion in the pulse plethysmograph (Pleth) as: A (true hypoxemia), both SpO decreased (only one Pleth showed motion); B (false hypoxemia), one SpO decreased (Pleth showed motion) and the other didn't (Pleth didn't show motion); C (suspected hypoxemia), both SpO decreased (both Pleth showed motion); D (true hypoxemia-motion free), both SpO decreased (neither Pleth showed motion).
RESULTS
In 24-72 h data from 20 infants of 25.4 ± 1.5 weeks GA, 14.1 ± 5.7 episodes with SpO < 90% and 7.9 ± 5.5 episodes with SpO < 80% per infant were identified. 29 ± 15% of episodes with SpO < 90% were type A, 1 ± 2% B, 43 ± 21% C and 27 ± 23% D, while 26 ± 22% of episodes with SpO < 80% were type A, 0.3 ± 1.2% B, 45 ± 29% C, and 19 ± 25% D [p < 0.001 type B vs. rest (GLM-repeated measures)].
CONCLUSION
In extremely premature infants SpO with motion artifact is more likely to indicate true- than false hypoxemia.
IMPACT
Uncertainty on the effect of motion on SpO accuracy during hypoxemia episodes in premature infants can influence the caregiver's trust on SpO and influence their response. This study evaluated data from two pulse oximeters used simultaneously in different extremities to determine the reliability of SpO during motion artifact in premature infants. Data from this study showed that in extremely premature infants SpO is more likely to indicate true- than false hypoxemia during episodes of hypoxemia associated with motion artifact.
背景
通过脉搏血氧仪（SpO）检测早产儿间歇性低氧血症（IH），但运动伪影可导致读数过低。
目的
评估在通过 2 个脉搏血氧仪监测的≤28 周胎龄早产儿中，与运动相关的 IH 发作期间脉搏血氧仪（SpO）的可靠性。
方法
根据运动对脉搏容积描记图（Pleth）引起的失真，使用基于分析工具将 IH 发作（定义为 SpO<90%，>10 s 和 SpO<80%，>10 s）分类为：A（真正的低氧血症），两个 SpO 下降（只有一个 Pleth 显示运动）；B（假性低氧血症），一个 SpO 下降（Pleth 显示运动），另一个不下降（Pleth 未显示运动）；C（疑似低氧血症），两个 SpO 下降（两个 Pleth 均显示运动）；D（真正的低氧血症-无运动），两个 SpO 下降（两个 Pleth 均未显示运动）。
结果
在 25.4±1.5 周胎龄的 20 名婴儿 24-72 小时的数据中，每例婴儿分别识别出 14.1±5.7 次 SpO<90%和 7.9±5.5 次 SpO<80%的发作。29±15%的 SpO<90%发作属于 A 型，1±2%为 B 型，43±21%为 C 型，27±23%为 D 型，而 26±22%的 SpO<80%发作属于 A 型，0.3±1.2%为 B 型，45±29%为 C 型，19±25%为 D 型[p<0.001 型 B 与其余类型（GLM-重复测量）]。
结论
在极早产儿中，有运动伪影的 SpO 更有可能指示真正的低氧血症，而不是假的低氧血症。
影响
在早产儿低氧血症发作期间，运动对 SpO 准确性的影响的不确定性可能会影响护理人员对 SpO 的信任，并影响他们的反应。本研究同时在不同肢体上使用两个脉搏血氧仪来评估数据，以确定在运动伪影期间 SpO 在极早产儿中的可靠性。本研究的数据表明，在极早产儿中，与运动相关的低氧血症发作期间，SpO 更有可能指示真正的低氧血症，而不是假的低氧血症。
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