[罂粟摘要]出生第一周的新生儿动脉血压在胎龄方面的依赖性变化：参考值和模型的建立

出生第一周的新生儿动脉血压在胎龄方面的依赖性变化：参考值和模型的建立

贵州医科大学     麻醉与心脏电生理课题组

翻译 :  柏雪     编辑 :  严旭    审校 :  曹莹

背景：动脉压测量对于监测新生儿的生命功能很重要，并且动脉压取决于胎龄和产后年龄。目前新生儿平均动脉压的参考范围是从小样本中无创和有创监测的综合数据中得出。我们目的是为在出生第一周内的新生儿（包括健康的早产和足月的新生儿）确定无创平均血压、收缩压和舒张压的参考值。

方法：在荷兰三级儿科医院新生儿重症监护病房 (NICU) 进行的这项回顾性队列研究中，我们收集了 2016 年至 2018 年期间入院的新生儿无创血压监测数据，排除了患有严重合并症（主要为心脏畸形、脑出血和气管插管 >6 小时）的新生儿。我们使用分位数回归 （标准差-2 sd [P0.23]、-1 sd [P16]、+1 sd [P84] 和+2 sd [P97.7]）定义了胎龄和产后年龄的中位数 (P50)。 

结果：   共607名新生儿符合纳入标准，进行了 5885 次测量。极端早产儿（出生时不足28周）的平均无创动脉血压P50值在出生后第一天急剧增加，并在一周内逐渐增加，且在24h时从27mmHg到49mmHg，而在胎龄到41周时从49mmHg到61mmHg。

结论：确定不同胎龄组新生儿无创血压的参考值，为健康和患病新生儿在麻醉和镇静期间的临床诊治提供了指导。

原始文献来源 ：  

Arjan C. van Zadelhof, Jarinda A. Poppe, Sten Willemsen, et, al. Age-dependent changes in arterial blood pressure in neonates during the first week of life: reference values and development of a model. 1 September 2022; Accepted: 25 January 2023.

Age-dependent changes in arterial blood pressure in neonates during the first week of life: reference values and development of a model

Background: Arterial pressure measurements are important to monitor vital function in neonates, and values are known to be dependent of gestational and postnatal age. Current reference ranges for mean arterial pressure in neonates have been derived from small samples and combined data of noninvasive and invasive measurements. We aimed to define reference values for noninvasive mean, systolic, and diastolic blood pressure during the first week of life in otherwise healthy preterm and term neonates defined by gestational and postnatal age.

Methods: In this retrospective cohort study in a neonatal intensive care unit (NICU) in a Dutch tertiary paediatric hospital, we included the noninvasive blood pressures of neonates admitted between 2016 and 2018, with exclusion of those with severe comorbidities (major cardiac malformations, intracerebral haemorrhage, and tracheal intubation >6h). We defined the median (P50) with -2 standard deviations (SD) (P0.23), -1 SD (P16), +1SD (P84), and+2SD (P97.7) for gestational age and postnatal age using quantile regression, percentiles provided online .

Results: A total of 607 neonates, with 5885 measurements, fulfilled the inclusion criteria. The P50 values of mean noninvasive arterial blood pressure in extreme preterm infants steeply increased during the first day after birth and gradually increased within a week from 27 to 49 mm Hg at 24 h of gestational age, and from 49 to 61 mm Hg at 41 weeks of gestational age.

Conclusions: These reference values for noninvasive blood pressure in neonates in the NICU for various gestational age groups provide guidance for clinical decision-making in healthy and diseased neonates during anaesthesia and sedation.

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