中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
22期
1716-1720
,共5页
卫敏超%余加林%刘晓红%齐利峰
衛敏超%餘加林%劉曉紅%齊利峰
위민초%여가림%류효홍%제리봉
支气管肺发育不良%呼吸功能试验%功能残气量%婴儿,早产
支氣管肺髮育不良%呼吸功能試驗%功能殘氣量%嬰兒,早產
지기관폐발육불량%호흡공능시험%공능잔기량%영인,조산
Bronchopulmonary dysplasia%Respiratory function tests%Function residual capacity%Infant,premature
目的 探讨不同程度支气管肺发育不良(BPD)患儿潮气肺功能特征.方法 2011年1月至2012年10月在深圳市儿童医院新生儿科及新生儿重症监护病房住院或门诊随访患儿407例,男278例、女129例.其中足月儿188例(足月组),非BPD早产儿113例(非BPD早产儿组),BPD早产儿106例(BPD组),BPD组根据BPD程度分为轻、中、重3组,分别为48、42、16例.所有患儿均除外先天性心脏病、先天性膈疝及咽喉部先天性畸形等影响肺功能的疾病.在校正胎龄44周各组进行潮气呼吸肺功能检测.q检验或Dunnett C检验进行组间比较,Spearman相关性分析评价各指标与BPD严重程度.结果 测试时年龄17～116 d,测试时体重1.83 ～7.00 kg,测试时身长40.0 ～64.0cm.非BPD早产儿组呼吸频率高于足月组[(50±13)比(44±10)次/min,P＜0.01],潮气量、达峰时间比(Tpef/Te)、呼气峰流速(TPEF)则均低于足月组[(25±9)比(29±7)ml、29％±9％比33％±8％、(59 ±23)比(65±25) ml/s,均P＜0.05],两组功能残气量(FRC)和肺清除指数(LCI)差异均无统计学意义[(20±5)比(19±5)ml/kg,8.4±2.8比8.7±3.4,均P＞0.05)].BPD中、重组呼吸频率[(57±9)、(58±10)次/min]均高于非BPD早产儿组(均P＜0.05),BPD轻组呼吸频率[(53±13)次/min]与非BPD早产儿组差异无统计学意义(P＞0.05).BPD轻、中、重组潮气量和LCI与非BPD早产儿组差异均无统计学意义(均P＞0.05),Tpef/Te和FRC除BPD轻组[24％±13％,(18±5)ml/kg]与非BPD早产儿组差异均无统计学意义(均P＞0.05)外,中、重组[20％±9％、18％±5％,(15±3)、(15 ±4) ml/kg]均低(均P＜0.05),TPEF则只有重组[(85±11)ml/s]高于非BPD早产儿组(P＜0.05).除LCI外,各指标与BPD严重程度均显著相关(均P＜0.05).结论 非BPD早产儿和BPD患儿均有不同程度的呼吸节律改变,肺容量降低、通气不均一,通气效率低,小气道阻力增大.中、重度BPD患儿有明显的肺弹性回缩力增加和大气道狭窄.
目的 探討不同程度支氣管肺髮育不良(BPD)患兒潮氣肺功能特徵.方法 2011年1月至2012年10月在深圳市兒童醫院新生兒科及新生兒重癥鑑護病房住院或門診隨訪患兒407例,男278例、女129例.其中足月兒188例(足月組),非BPD早產兒113例(非BPD早產兒組),BPD早產兒106例(BPD組),BPD組根據BPD程度分為輕、中、重3組,分彆為48、42、16例.所有患兒均除外先天性心髒病、先天性膈疝及嚥喉部先天性畸形等影響肺功能的疾病.在校正胎齡44週各組進行潮氣呼吸肺功能檢測.q檢驗或Dunnett C檢驗進行組間比較,Spearman相關性分析評價各指標與BPD嚴重程度.結果 測試時年齡17～116 d,測試時體重1.83 ～7.00 kg,測試時身長40.0 ～64.0cm.非BPD早產兒組呼吸頻率高于足月組[(50±13)比(44±10)次/min,P＜0.01],潮氣量、達峰時間比(Tpef/Te)、呼氣峰流速(TPEF)則均低于足月組[(25±9)比(29±7)ml、29％±9％比33％±8％、(59 ±23)比(65±25) ml/s,均P＜0.05],兩組功能殘氣量(FRC)和肺清除指數(LCI)差異均無統計學意義[(20±5)比(19±5)ml/kg,8.4±2.8比8.7±3.4,均P＞0.05)].BPD中、重組呼吸頻率[(57±9)、(58±10)次/min]均高于非BPD早產兒組(均P＜0.05),BPD輕組呼吸頻率[(53±13)次/min]與非BPD早產兒組差異無統計學意義(P＞0.05).BPD輕、中、重組潮氣量和LCI與非BPD早產兒組差異均無統計學意義(均P＞0.05),Tpef/Te和FRC除BPD輕組[24％±13％,(18±5)ml/kg]與非BPD早產兒組差異均無統計學意義(均P＞0.05)外,中、重組[20％±9％、18％±5％,(15±3)、(15 ±4) ml/kg]均低(均P＜0.05),TPEF則隻有重組[(85±11)ml/s]高于非BPD早產兒組(P＜0.05).除LCI外,各指標與BPD嚴重程度均顯著相關(均P＜0.05).結論 非BPD早產兒和BPD患兒均有不同程度的呼吸節律改變,肺容量降低、通氣不均一,通氣效率低,小氣道阻力增大.中、重度BPD患兒有明顯的肺彈性迴縮力增加和大氣道狹窄.
목적 탐토불동정도지기관폐발육불량(BPD)환인조기폐공능특정.방법 2011년1월지2012년10월재심수시인동의원신생인과급신생인중증감호병방주원혹문진수방환인407례,남278례、녀129례.기중족월인188례(족월조),비BPD조산인113례(비BPD조산인조),BPD조산인106례(BPD조),BPD조근거BPD정도분위경、중、중3조,분별위48、42、16례.소유환인균제외선천성심장병、선천성격산급인후부선천성기형등영향폐공능적질병.재교정태령44주각조진행조기호흡폐공능검측.q검험혹Dunnett C검험진행조간비교,Spearman상관성분석평개각지표여BPD엄중정도.결과 측시시년령17～116 d,측시시체중1.83 ～7.00 kg,측시시신장40.0 ～64.0cm.비BPD조산인조호흡빈솔고우족월조[(50±13)비(44±10)차/min,P＜0.01],조기량、체봉시간비(Tpef/Te)、호기봉류속(TPEF)칙균저우족월조[(25±9)비(29±7)ml、29％±9％비33％±8％、(59 ±23)비(65±25) ml/s,균P＜0.05],량조공능잔기량(FRC)화폐청제지수(LCI)차이균무통계학의의[(20±5)비(19±5)ml/kg,8.4±2.8비8.7±3.4,균P＞0.05)].BPD중、중조호흡빈솔[(57±9)、(58±10)차/min]균고우비BPD조산인조(균P＜0.05),BPD경조호흡빈솔[(53±13)차/min]여비BPD조산인조차이무통계학의의(P＞0.05).BPD경、중、중조조기량화LCI여비BPD조산인조차이균무통계학의의(균P＞0.05),Tpef/Te화FRC제BPD경조[24％±13％,(18±5)ml/kg]여비BPD조산인조차이균무통계학의의(균P＞0.05)외,중、중조[20％±9％、18％±5％,(15±3)、(15 ±4) ml/kg]균저(균P＜0.05),TPEF칙지유중조[(85±11)ml/s]고우비BPD조산인조(P＜0.05).제LCI외,각지표여BPD엄중정도균현저상관(균P＜0.05).결론 비BPD조산인화BPD환인균유불동정도적호흡절률개변,폐용량강저、통기불균일,통기효솔저,소기도조력증대.중、중도BPD환인유명현적폐탄성회축력증가화대기도협착.
Objective To explore the characteristics of lung function in preterm infants with varying degrees of bronchopulmonary dysplasia (BPD).Methods There were 407 infants (278 males and 129 females) were recruited from Shenzhen Children' Hospital between January 2011 and October 2012.Among them 188 term infants (term group)and 113 preterm infants (non-BPD preterm group) were selected as controls.A total of 106 BPD infants from the observation group were divided into mild(n =48),moderate (n =42) and severe(n =16) sub-groups according to the definition of BPD.Infants with diseases interfering with lung function,such as congenital heart disease,congenital diaphragmatic hernia,or thoracic wall deformities,were excluded.Lung function was tested at a postmenstrual age (PMA) of 44 weeks.q test,Dunnett C test and Spearman analysis were used for statistical analysis.Results The age range was 17-116 d,test weight range 1.83-7.00 kg and test height range 40.0-64.0 cm.In non-BPD preterm group,the respiratory rate (RR) was higher than that in term group((50 ± 13) vs (44 ± 10) times/min,P ＜0.01),while the tidal volume(TV),ratio of time to peak tidal expiratory time and expiratory time (Tpet/Te) and peak expiratory flow(TPEF) were all less than those in term group((25 ±9) vs (29 ±7)ml,29％ ±9％ vs 33％ ± 8％,(59 ± 23) vs (65 ± 25) ml/s,all P ＜ 0.05).Neither functional residual capacity(FRC) nor lung clearance index (LCI) had significant statistical difference between two groups ((20 ± 5) vs (19 ± 5) ml/kg,8.4 ± 2.8 vs 8.7 ± 3.4,all P ＞ 0.05)).In moderate and severe BPD groups,RR ((57 ± 9),(58 ± 10) times/min)were both higher than that in non-BPD group(both P ＜ 0.05) while RR in mild group ((53 ± 13) times/min) had no statistical significant difference with non-BPD group (P ＞ 0.05).The values of TV and LCI in mild,moderate and severe BPD groups have no statistical significance with non-BPD group (all P ＞ 0.05).Except for mild BPD group (24％ ± 13％,(18 ± 5) ml/kg),Tpef/Te and FRC in both moderate and severe groups (20％ ± 9％ and 18％ ± 5％,(15 ± 3) and (15 ± 4) ml/kg) were less than those in non-BPD group (all P ＜ 0.05).Only in severe BPD group ((85 ± 11) ml/s),TPEF was higher than that in non-BPD group (P ＜ 0.05).Correlation analysis showed that,except for LCI,all of these parameters were significantly associated with the degree of BPD(all P ＜ 0.05).Conclusions For BPD and non-BPD preterm infants,there are various changes in respiratory rhythme,lung volume,ventilation inhomogeneity,ventilatory efficiency and small airway resistance.The increases of pulmonary elastic recoil and degree of major airway constriction are obvious in moderate and severe BPD infants.
