Silvestri J M, Weese-Mayer D E, Kenny A S, Hauptman S A
Department of Pediatrics, Rush Medical College of Rush University, Chicago, Illinois.
J Pediatr. 1994 Jul;125(1):51-6. doi: 10.1016/s0022-3476(94)70120-2.
We assessed children referred to our apnea program who were > or = 12 months of age, beyond the at-risk period for sudden infant death syndrome (SIDS), but for whom home cardiorespiratory monitoring had continued. Our objectives were to (1) determine reasons for initiation and continuation of monitoring, (2) apply documented monitoring of transthoracic impedance, electrocardiographic signals, and, in a subset of patients, pulse oximetry, to determine the types of cardiorespiratory events that these children experienced, and (3) describe how documented monitoring was applied for eventual discontinuation of monitoring. Among 45 patients (median age, 22 months), 263 disks were collected, representing 2982 monitor days. Indications for initiation of monitoring included an apparent life-threatening event in 51.1% of patients, apnea of prematurity in 35.5%, history of SIDS or apparent life-threatening event in a relative in 9%, and intrauterine drug exposure in 4.4%. Continuation of monitoring had been based on continued alarms and, in 31% of patients, documented apnea, bradycardia, or hemoglobin desaturation. In 40 of 45 patients, 2292 episodes of apnea (17.5% of all events) were recorded (range, 16 to 31 seconds). Five patients had 223 episodes of bradycardia (1.7% of all events). Of all 13,075 recorded events, 76.8% resulted in audible alarms, but only 3.9% of these alarms were for apnea and 2.2% were for bradycardia. Of 19 patients studied with pulse oximetry, 18 had 663 episodes of hemoglobin desaturation <90%. All children were thriving at the time of referral. Discontinuation of monitoring was based on a child's ability to resume breathing spontaneously or on normalization of heart rate or hemoglobin saturation before the audible alarm sounded, for a minimum of 2 to 3 months. By extension of the audible apnea alarm to 25 or 30 seconds, lowering of the cutoff point for bradycardia alarm, or lowering of the cutoff point for the oximetry alarm, a recommendation to discontinue monitoring could be made for 41 patients. Of these, no child had a recurrence of cardiorespiratory events or died of SIDS. Documented monitoring proved to be a useful clinical tool for investigation of the clinical and physiologic importance of these cardiorespiratory events in children beyond the at-risk period for SIDS; recommendations about discontinuation of monitoring could be made knowledgeably and safely.
我们评估了被转介至我们的呼吸暂停项目的儿童，这些儿童年龄大于或等于12个月，已过婴儿猝死综合征（SIDS）的高危期，但仍在进行家庭心肺监测。我们的目标是：（1）确定开始和持续监测的原因；（2）应用记录的经胸阻抗、心电图信号监测，以及对部分患者进行脉搏血氧饱和度监测，以确定这些儿童经历的心肺事件类型；（3）描述如何应用记录监测来最终停止监测。在45例患者（中位年龄22个月）中，收集了263个磁盘，代表2982个监测日。开始监测的指征包括：51.1%的患者有明显危及生命的事件，35.5%的患者有早产呼吸暂停，9%的患者有SIDS或亲属中有明显危及生命事件的病史，4.4%的患者有宫内药物暴露史。监测的持续是基于持续的警报，31%的患者记录到呼吸暂停、心动过缓或血红蛋白饱和度下降。45例患者中的40例记录到2292次呼吸暂停发作（占所有事件的17.5%）（范围为16至31秒）。5例患者有223次心动过缓发作（占所有事件的1.7%）。在所有记录的13075次事件中，76.8%导致可听警报，但这些警报中只有3.9%是针对呼吸暂停，2.2%是针对心动过缓。在19例进行脉搏血氧饱和度监测的患者中，18例有663次血红蛋白饱和度<90%的发作。所有儿童在转诊时均发育良好。监测的停止基于儿童在可听警报响起前能够自发恢复呼吸或心率或血红蛋白饱和度恢复正常，且至少持续2至3个月。通过将可听呼吸暂停警报延长至25或30秒、降低心动过缓警报的临界值或降低血氧饱和度监测警报的临界值，可以对41例患者提出停止监测的建议。其中，没有儿童出现心肺事件复发或死于SIDS。记录监测被证明是一种有用的临床工具，可用于调查这些心肺事件在SIDS高危期之后儿童中的临床和生理重要性；关于停止监测的建议可以在知情且安全的情况下做出。
