Poets C F, Samuels M P, Noyes J P, Hewertson J, Hartmann H, Holder A, Southall D P
Academic Department of Paediatrics, University of Keele, North Staffordshire Hospital Centre, Stoke-on-Trent, United Kingdom.
J Pediatr. 1993 Nov;123(5):693-701. doi: 10.1016/s0022-3476(05)80842-x.
For an evaluation of the usefulness of event recording in identifying mechanisms for apparent life-threatening events, 94 infants (median age, 3.1 months; range, 0.5 to 12 months) with a history of two or more apparent life-threatening events of hitherto unknown cause underwent event recording of transcutaneous oxygen pressure, arterial oxygen saturation, (not recorded in all patients), breathing movements, pulse waveforms, electrocardiogram, and instantaneous heart rate. Recordings were triggered by a fall in transcutaneous oxygen pressure to less than 20 mm Hg. During a median duration of event recording of 1.3 months (0.1 to 10 months), 52 events were recorded in 34 patients; 7 of the events had to be excluded because of uninterpretable signals. The following mechanisms were identified in the remaining 30 patients (45 events): a sudden change in skin perfusion but without hypoxemia (6 in 5 patients), hypoxemia induced by an epileptic seizure (6 in 5 patients), hypoxemia induced by suffocation by a parent (4 in 4 patients), and parental fabrication of events and medical history (7 in 6 patients). In the remaining 22 events in 12 patients, the precise mechanism of events could not be identified. Analysis of these as-yet-unexplained events showed prolonged abnormal hypoxemia (a fall in transcutaneous oxygen pressure to between 4 and 18 mm Hg and a fall in arterial oxygen saturation to 5% to 75%), lasting for 40 to 500 seconds in all. Only five of these events involved prolonged (> 20 seconds) apneic pauses, and only four an episode of bradycardia (heart rate < 80 or 60 beats/min). Thus event recording identified various mechanisms of apparent life-threatening events. In the events that remained unexplained, prolonged apneic pauses or episodes of bradycardia were found in only a minority. The identification of hypoxemia therefore may be more relevant to the early detection of these events than the identification of apnea or bradycardia or both. The relevance of these findings with regard to sudden infant death syndrome remains to be determined.
为评估事件记录在识别不明原因的明显危及生命事件机制方面的实用性，对94例有两次或更多次不明原因的明显危及生命事件病史的婴儿（中位年龄3.1个月；范围0.5至12个月）进行了经皮氧分压、动脉血氧饱和度（并非所有患者均记录）、呼吸运动、脉搏波形、心电图和瞬时心率的事件记录。记录由经皮氧分压降至低于20mmHg触发。在事件记录的中位持续时间1.3个月（0.1至10个月）内，34例患者记录到52次事件；其中7次事件因信号无法解读而被排除。在其余30例患者（45次事件）中确定了以下机制：皮肤灌注突然改变但无低氧血症（5例患者中的6次）、癫痫发作诱发的低氧血症（5例患者中的6次）、父母窒息导致的低氧血症（4例患者中的4次）以及父母编造事件和病史（6例患者中的7次）。在其余12例患者的22次事件中，无法确定事件的确切机制。对这些尚未解释的事件分析显示，存在持续时间较长的异常低氧血症（经皮氧分压降至4至18mmHg，动脉血氧饱和度降至5%至75%），持续时间总计40至500秒。这些事件中只有5次涉及长时间（>20秒）的呼吸暂停，只有4次出现心动过缓发作（心率<80或60次/分钟）。因此，事件记录识别出了明显危及生命事件的各种机制。在仍无法解释的事件中，只有少数出现长时间的呼吸暂停或心动过缓发作。因此，与呼吸暂停或心动过缓单独或两者同时识别相比，低氧血症的识别可能与这些事件的早期检测更相关。这些发现与婴儿猝死综合征的相关性仍有待确定。
