呼吸窘迫综合征对中期早产儿潮气呼吸肺功能指标影响研究
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摘要
目的探讨呼吸窘迫综合征(RDS)对中期早产儿潮气呼吸肺功能指标的影响。方法选择2013年7月至2015年7月株洲市妇幼保健院新生儿科早产儿65例,胎龄32~34周;体质量1.235~1.856 kg,平均体质量1.510 kg;身高42~49 cm,平均身高45.0 cm。其中无RDS中期早产儿(无RDS组)35例,RDS中期早产儿(RDS组)30例。分别进行潮气呼吸肺功能指标检测,包括潮气量(VT)、呼吸频率(RR)、达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)。并在纠正胎龄达40周时与同期产科分娩的40周正常足月儿(正常组)进行潮气呼吸肺功能相比较。结果无RDS组体质量、身高分别为(1.57±0.43) kg、(43.45±0.89) cm,RDS组分别为(1.53±0.48) kg、(45.13±1.96) cm;两组比较,差异无统计学意义(t=1.026,P=0.23、0.07> 0.05)。无RDS组、RDS组在出生4周内VT、RR、TPTEF/TE、VPEF/VE等指标变化明显,差异有统计学意义(P <0.05)。在出生后第4周,无RDS组VT、TPTEF/TE、VPEF/VE均高于RDS组[(5.5±0.4) mL/kg vs(4.8±0.4) mL/kg,(36.24±4.18)%vs (32.34±5.35)%,(35.34±5.35)%vs (31.24±4.18)%],差异有统计学意义(P <0.05);无RDS组RR低于RDS组,差异有统计学意义(P <0.05)。无RDS组早产儿、RDS组早产儿与正常组新生儿在胎龄达40周时VT [(7.4±1.2) mL/kg、(6.7±0.9) mL/kg、(8.5±1.3) m L/kg]、RR [(36.9±4.1)次/分、(45.2±6.4)次/分、(37.5±4.43)次/分]、TPTEF/TE [(55.76±8.28)%、(48.17±7.32)%、(60.28±8.27)%]、VPEF/VE [(53.38±7.14)%、(46.13±6.29)%、(59.17±8.92)%]等肺功能指标比较,各项指标均明显偏低,差异有统计学意义(P <0.05)。结论中期早产儿肺功能参数随日龄增加可逐渐改善,RDS可显著影响中期早产儿的潮气呼吸肺功能指标,在纠正胎龄达40周时仍达不到正常足月儿。新生儿肺功能监测有助于评估中期早产儿特别是患有RDS的中期早产儿肺脏发育。
Objective To investigate the effects of respiratory distress syndrome(RDS) on pulmonary function indexes of tidal breathing in medium preterm infants. Methods From July 2013 to July 2015, a total of 65 cases of neonatal premature infants were enrolled, the gestational aged 32-34 weeks, body weight was 1.235-1.856 kg with mean of 1.510 kg, height 42-49 cm with mean of 45.0 cm. There were 35 non-RDS preterm infants(non-RDS group) and 30 RDS preterm infants(RDS group).The tidal breathing pulmonary function indexes of tidal volume(VT), respiratory rate(RR), peak-to-peak time ratio(TPTEF/TE),and peak volume ratio(VPEF/VE) were measured. At 40-week of correction gestational age, the tidal breathing function of preterm infants was compared with that of normal full-term infants delivered at 40-week. Results The body weight and height of non-RDS group were(1.57 ± 0.43) kg and(43.45 ± 0.89) cm, respectively, and RDS group were(1.53 ± 0.48) kg and(45.13 ± 1.96) cm. There was no significant difference between 2 groups(t = 1.026, P = 0.23, 0.07 > 0.05). There were significant changes in VT, RR, TPTEF/TE, VPEF/VE within 4 weeks of birth between non-RDS group and RDS group, and the differences were statistically significant(P < 0.05). At the 4-week after birth, VT, TPTEF/TE, and VPEF/VE of non-RDS group were higher than those of RDS group[(5.5 ± 0.4) m L/kg vs(4.8 ± 0.4) m L/kg,(36.24 ± 4.18) % vs(32.34 ± 5.35) %,(35.34 ±5.35) % vs(31.24 ± 4.18) %], and the differences were statistically significant(P < 0.05). The RR of non-RDS group was lower than that of RDS group, and the difference was statistically significant(P < 0.05). Compared with 40-week gestational age of normal full-term infants group, the pulmonary function of non-RDS and RDS were significant lower, which were VT[(7.4 ± 1.2) m L/kg,(6.7 ± 0.9) mL/kg,(8.5 ± 1.3) mL/kg], RR[(36.9 ± 4.1) times/minutes,(45.2 ± 6.4) times/minutes,(37.5 ± 4.43) times/minutes],TPTEF/TE[(55.76 ± 8.28) %,(48.17 ± 7.32) %,(60.28 ± 8.27) %] and VPEF/VE[(53.38 ± 7.14) %,(46.13 ± 6.29) %,(59.17 ±8.92) %], and the differences were statistically significant(P < 0.05). Conclusion It is demonstrated that the pulmonary function of medium preter infants parameters could be gradually improved with the increase of age, and RDS could significantly affect tidal respiratory pulmonary function in medium preterm infants, but their function after being corrected gestational age at40-week is not as good as full-term neonates. The neonatal pulmonary function monitoring could help to assess pulmonary development in medium preterm infants, especially medium preterm infants with RDS.
Objective To investigate the effects of respiratory distress syndrome(RDS) on pulmonary function indexes of tidal breathing in medium preterm infants. Methods From July 2013 to July 2015, a total of 65 cases of neonatal premature infants were enrolled, the gestational aged 32-34 weeks, body weight was 1.235-1.856 kg with mean of 1.510 kg, height 42-49 cm with mean of 45.0 cm. There were 35 non-RDS preterm infants(non-RDS group) and 30 RDS preterm infants(RDS group).The tidal breathing pulmonary function indexes of tidal volume(VT), respiratory rate(RR), peak-to-peak time ratio(TPTEF/TE),and peak volume ratio(VPEF/VE) were measured. At 40-week of correction gestational age, the tidal breathing function of preterm infants was compared with that of normal full-term infants delivered at 40-week. Results The body weight and height of non-RDS group were(1.57 ± 0.43) kg and(43.45 ± 0.89) cm, respectively, and RDS group were(1.53 ± 0.48) kg and(45.13 ± 1.96) cm. There was no significant difference between 2 groups(t = 1.026, P = 0.23, 0.07 > 0.05). There were significant changes in VT, RR, TPTEF/TE, VPEF/VE within 4 weeks of birth between non-RDS group and RDS group, and the differences were statistically significant(P < 0.05). At the 4-week after birth, VT, TPTEF/TE, and VPEF/VE of non-RDS group were higher than those of RDS group[(5.5 ± 0.4) m L/kg vs(4.8 ± 0.4) m L/kg,(36.24 ± 4.18) % vs(32.34 ± 5.35) %,(35.34 ±5.35) % vs(31.24 ± 4.18) %], and the differences were statistically significant(P < 0.05). The RR of non-RDS group was lower than that of RDS group, and the difference was statistically significant(P < 0.05). Compared with 40-week gestational age of normal full-term infants group, the pulmonary function of non-RDS and RDS were significant lower, which were VT[(7.4 ± 1.2) m L/kg,(6.7 ± 0.9) mL/kg,(8.5 ± 1.3) mL/kg], RR[(36.9 ± 4.1) times/minutes,(45.2 ± 6.4) times/minutes,(37.5 ± 4.43) times/minutes],TPTEF/TE[(55.76 ± 8.28) %,(48.17 ± 7.32) %,(60.28 ± 8.27) %] and VPEF/VE[(53.38 ± 7.14) %,(46.13 ± 6.29) %,(59.17 ±8.92) %], and the differences were statistically significant(P < 0.05). Conclusion It is demonstrated that the pulmonary function of medium preter infants parameters could be gradually improved with the increase of age, and RDS could significantly affect tidal respiratory pulmonary function in medium preterm infants, but their function after being corrected gestational age at40-week is not as good as full-term neonates. The neonatal pulmonary function monitoring could help to assess pulmonary development in medium preterm infants, especially medium preterm infants with RDS.
引文
[1] Wang J, Liu X, Zhu T, et al. Analysis of neonatal respiratory distress syndrome among different gestational segments[J].Int J Clin Exp Med, 2015, 8(9):16273-16279.
[2] Tochie JN, Choukem SP, Langmia RN, et al. Neonatal respiratory distress in a reference neonatal unit in Cameroon:an analysis of prevalence, predictors, etiologies and outcomes[J].Pan Afr Med J, 2016, 24:152-152.
[3] SHAO Xiao-mei, YE Hong-mao, QIU Xiao-shan. Practical neonatology[M]. 4th edition. Beijing:People’s Medical Publishing House, 2015.[邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].第4版.北京:人民卫生出版社,2015.]
[4] Reuter S, Moser C, Baack M. Respiratory distress in the newborn[J]. Pediatr Rev, 2014, 35(10):417-429.
[5] Zhou B, Zhai JF, Wu JB, et al. Different ventilation modes combined with ambroxol in the treatment of respiratory distress syndrome in premature infants[J]. Exp Ther Med, 2017,13(2):629-633.
[6] Shin J, Park K, Lee EH, et al. Humidified high flow nasal cannula versus nasal continuous positive airway pressure as an initial respiratory support in preterm infants with respiratory distress:a randomized, controlled non-inferiority trial[J].J Korean Med Sci, 2017, 32(4):650-655.
[7] ZHANG Hao, CAI Ying-yun. Method of lung function testing in infants[J]. Foreign Medical Sciences Section of Pediatrics,2004, 31(2):73-75.[张皓,蔡映云.婴幼儿肺功能检查的方法[J].国外医学儿科学分册,2004,31(2):73-75.]
[8] TANG Ke-qiang, YU Quan-min, GUO Hong. Treatment of acute respiratory distress syndrome by mechanical mask ventilation[J]. Section of Respiratory System Foreign Medical Sciences, 2005, 25(7):558-558.[唐克强,余全民,郭红.经面罩机械通气治疗急性呼吸窘迫综合征[J].国外医学呼吸系统分册,2005,25(7):558-558.]
[9] CHENG Ke-ping, YANG Ai-juan, HU Yuan, et al. Study on tidal breathing lung function in late preterm infants[J]. Chinese Pediatric Emergency Medicine, 2011, 18(5):449-451.[程可萍,杨爱娟,胡源,等.晚期早产儿潮气呼吸肺功能研究[J].中国小儿急救医学,2011,18(5):449-451.]
[10] Friedrich L, Pitrez PM, Stein RT, et al. Growth rate of lung function in healthy preterm infants[J]. Am J Respir Crit Care Med, 2007, 176(12):1269-1273.
[11] McEvoy C, Venigalla S, Schilling D, et al. Respiratory function in healthy late preterm infants delivered at 33-36weeks of gestation[J]. J Pediatr, 2013, 162(3):464-469.
[12] Volls覸ter M, Skromme K, Satrell E, et al. Children born preterm at the turn of the millennium had better lung function than children born similarly preterm in the early 1990s[J]. PLoS One, 2015, 10(12):e0144243-e0144243.
[13] JI Ling, MA Li-ya, HUANG Na-na. Measurement of tidal breathing pulmonary function in premature infants with different gestational ages[J]. Chinese Journal of Contemporary Pediatrics, 2015, 17(5):449-452.[吉玲,马莉雅,黄娜娜.不同胎龄早产儿潮气呼吸肺功能的测定及分析[J].中国当代儿科杂志,2015,17(5):449-452.]
[2] Tochie JN, Choukem SP, Langmia RN, et al. Neonatal respiratory distress in a reference neonatal unit in Cameroon:an analysis of prevalence, predictors, etiologies and outcomes[J].Pan Afr Med J, 2016, 24:152-152.
[3] SHAO Xiao-mei, YE Hong-mao, QIU Xiao-shan. Practical neonatology[M]. 4th edition. Beijing:People’s Medical Publishing House, 2015.[邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].第4版.北京:人民卫生出版社,2015.]
[4] Reuter S, Moser C, Baack M. Respiratory distress in the newborn[J]. Pediatr Rev, 2014, 35(10):417-429.
[5] Zhou B, Zhai JF, Wu JB, et al. Different ventilation modes combined with ambroxol in the treatment of respiratory distress syndrome in premature infants[J]. Exp Ther Med, 2017,13(2):629-633.
[6] Shin J, Park K, Lee EH, et al. Humidified high flow nasal cannula versus nasal continuous positive airway pressure as an initial respiratory support in preterm infants with respiratory distress:a randomized, controlled non-inferiority trial[J].J Korean Med Sci, 2017, 32(4):650-655.
[7] ZHANG Hao, CAI Ying-yun. Method of lung function testing in infants[J]. Foreign Medical Sciences Section of Pediatrics,2004, 31(2):73-75.[张皓,蔡映云.婴幼儿肺功能检查的方法[J].国外医学儿科学分册,2004,31(2):73-75.]
[8] TANG Ke-qiang, YU Quan-min, GUO Hong. Treatment of acute respiratory distress syndrome by mechanical mask ventilation[J]. Section of Respiratory System Foreign Medical Sciences, 2005, 25(7):558-558.[唐克强,余全民,郭红.经面罩机械通气治疗急性呼吸窘迫综合征[J].国外医学呼吸系统分册,2005,25(7):558-558.]
[9] CHENG Ke-ping, YANG Ai-juan, HU Yuan, et al. Study on tidal breathing lung function in late preterm infants[J]. Chinese Pediatric Emergency Medicine, 2011, 18(5):449-451.[程可萍,杨爱娟,胡源,等.晚期早产儿潮气呼吸肺功能研究[J].中国小儿急救医学,2011,18(5):449-451.]
[10] Friedrich L, Pitrez PM, Stein RT, et al. Growth rate of lung function in healthy preterm infants[J]. Am J Respir Crit Care Med, 2007, 176(12):1269-1273.
[11] McEvoy C, Venigalla S, Schilling D, et al. Respiratory function in healthy late preterm infants delivered at 33-36weeks of gestation[J]. J Pediatr, 2013, 162(3):464-469.
[12] Volls覸ter M, Skromme K, Satrell E, et al. Children born preterm at the turn of the millennium had better lung function than children born similarly preterm in the early 1990s[J]. PLoS One, 2015, 10(12):e0144243-e0144243.
[13] JI Ling, MA Li-ya, HUANG Na-na. Measurement of tidal breathing pulmonary function in premature infants with different gestational ages[J]. Chinese Journal of Contemporary Pediatrics, 2015, 17(5):449-452.[吉玲,马莉雅,黄娜娜.不同胎龄早产儿潮气呼吸肺功能的测定及分析[J].中国当代儿科杂志,2015,17(5):449-452.]