To examine predictive value of the hemodynamic indexes for BPD in premature infants.

One hundred and sixty-one premature infants (hospitalized within 1 hour of birth, gestational age <32 weeks) were selected from Xinxiang Central Hospital from September 2018 to December 2020. The general data (gestational age, birth weight, sex, and mode of delivery) were collected; the basic diseases and other complications of preterm infants were collected, compared between two groups of infants divided by the prevalence of BPD (n=65) or not (n=96) . PI values (measured at 1, 12, 48, 72 and 96 hours after delivery, and on the 5th, 6th, and 7th days after delivery, respectively) , and serum lactic acid levels (measured at 1, 12, and 24 hours after admission, respectively) were collected. Mean arterial pressure (MAP) levels measured by arterial pressure monitoring at 1, 12 and 24 hours after admission for 33 infants (16 in BPD group and 17 in the control group) with critical or extremely critical conditions suggested by neonatal critical illness score were also collected. Compare the results between two groups, the receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of PI, serum lactic acid and MAP for BPD in preterm infants.

Sixty-five out of the 161 cases 〔40.3% (65/161) 〕were diagnosed with BPD. Preterm infants with and without BPD had no statistically significant differences in gestational age, birth weight, gender, and mode of delivery (P>0.05) . Preterm infants with BPD had higher incidence of neonatal asphyxia, neonatal respiratory distress syndrome, neonatal pneumonia, and retinopathy of prematurity than those without (P<0.05) . Preterm infants with and without BPD had no statistically significant differences in sepsis, pulmonary hemorrhage, PDA, IVH, purulent meningitis and anemia (P>0.05) . PI values at 1, 12 and 24 hours after birth differed significantly between the two groups (P<0.05) . Serum lactic acid at 1 hour after admission differed significant between the two groups (P<0.05) . MAP levels at different time periods showed no significant differences between critical and extremely critical preterm infants with and without BPD (P>0.05) . In predicting BPD, the PI at 1-hour, 12-hour, and 24-hour was 0.847〔95%CI (0.788, 0.906) , P<0.001〕, 0.776〔95%CI (0.705, 0.846) , P<0.001〕, 0.695〔95%CI (0.613, 0.778) , P<0.001〕, respectively; the optimal cutoff value was chosen as 0.55, 1.15, 1.45, with the sensitivity of 76.9%, 86.2%, 81.5% and the specificity of 75.0%, 60.4%, 51.0%; serum lactic acid at 1 hour after birthhad an AUC of 0.762〔95%CI (0.686, 0.837) , P<0.001〕, the optimal cutoff value was chosen as 6.55, with the sensitivity of 81.5%, and the specificity of 68.7%.

In preterm infants with a gestational age <32 weeks, the change of hemodynamic indicatou PI and lactic acid value maybe correlated with the occurrence of BPD. PI value within 24 hours after birth may be an earlypredictor for BPD, but further research is still needed.

探讨血流动力学指标对早产儿发生BPD的预测价值。

选取新乡市中心医院2018年9月至2020年12月收治的出生1 h内入院的161例胎龄<32周的早产儿为研究对象。收集早产儿一般资料，包括胎龄、出生体质量、性别、分娩方式；记录早产儿基础疾病及并发症，根据早产儿是否发生BPD将其分为BPD组（n=65）和对照组（n=96）。记录早产儿出生后1 h、12 h、24 h、48 h、72 h、96 h、5 d、6 d、7 d的脉搏灌注指数（PI）；记录早产儿入院后1 h、12 h及24 h的血乳酸值；根据新生儿危重病例评分（NCIS），选择病情危重和极危重的早产儿33例（其中BPD组16例，对照组17例）进行有创动脉血压监测，并记录监测1 h、12 h、24 h的平均动脉压（MAP）。比较两组患儿检查结果，应用受试者工作特征曲线（ROC曲线）评估PI、血乳酸值对早产儿发生BPD的预测价值。

确诊BPD早产儿共65例，发病率40.3%（65/161）。两组早产儿胎龄、出生体质量、性别、分娩方式比较，差异无统计学意义（P>0.05）；BPD组新生儿窒息、新生儿呼吸窘迫综合征、新生儿肺炎及ROP发生率高于对照组（P<0.05）；两组早产儿败血症、动脉导管未闭、肺出血、脑室内出血、化脓性脑膜炎、贫血发生率比较，差异无统计学意义（P>0.05）。两组早产儿出生后1 h、12 h及24 h的PI比较，差异均有统计学意义（P<0.05）；两组早产儿入院后1 h血乳酸值比较，差异有统计学意义（P<0.05）；两组中病情危重和极危重早产儿不同时段MAP比较，差异无统计学意义（P>0.05）。出生后1 h、12 h、24 h PI预测BPD发生的ROC曲线下面积（AUC）分别为0.847〔95%CI（0.788，0.906），P<0.001〕、0.776〔95%CI（0.705，0.846），P<0.001〕、0.695〔95%CI（0.613，0.778），P<0.001〕；最佳截断值分别为0.55、1.15、1.45；灵敏度分别为76.9%、86.2%、81.5%；特异度分别为75.0%、60.4%、51.0%；入院后1 h血乳酸值预测BPD发生的AUC为0.762〔95%CI（0.686，0.837），P<0.001〕，最佳截断值为6.55，灵敏度为81.5%，特异度为68.7%。

血流动力学指标PI及乳酸值的改变与早产儿BPD的发生具有相关性，胎龄<32周早产儿出生后24 h内PI对于BPD的预测有一定价值，但仍需进一步研究。