
呼吸窘迫综合征新生儿治疗后潮气呼吸肺功能检测
Tidal breathing pulmonary function after treatment in neonates with respiratory distress syndrome
目的 探讨不同胎龄以及不同程度的呼吸窘迫综合征 (RDS) 新生儿经治疗后肺功能的情况。方法 107例RDS新生儿分为小于34周早产儿组 (65例),晚期早产儿组 (21例) 及足月儿组 (21例),同时选取121例非RDS患儿作为对照组。根据RDS程度将RDS新生儿分为轻度RDS (1、2级) 及重度RDS (3、4级)。于纠正胎龄44周时行潮气呼吸肺功能测定。结果 不同胎龄RDS新生儿的肺功能参数未见明显差异;RDS组的达峰时间比 (TPEF/tE)、达峰容积比 (VPEF/VE) 较同胎龄对照组小 (P < 0.05);两组不同程度RDS新生儿于纠正胎龄44周时TPEF/tE、VPEF/VE也低于对照组 (P < 0.05),且随着RDS程度加重,其值呈下降趋势。结论 RDS新生儿纠正胎龄44周时肺功能水平明显低于非RDS新生儿;RDS新生儿纠正胎龄44周时潮气呼吸肺功能水平与胎龄无关,主要与RDS严重程度有关。
Objective To investigate the pulmonary function after treatment in neonates with respiratory distress syndrome (RDS) at varying disease severity levels and different gestational ages. Methods A total of 107 neonates with RDS were divided into <34 weeks group (65 neonates), late preterm group (21 neonates), full-term group (21 neonates). Another 121 non-RDS children were enrolled as the control group. According to the severity of RDS, the RDS neonates were divided into mild RDS group (grades 1 and 2; 76 neonates), and severe RDS (grades 3 and 4; 21 neonates). The tidal breathing pulmonary function was measured at a corrected gestational age of 44weeks. Results The pulmonary function parameters showed no significant differences across the groups of RDS neonates of different gestational ages; the tidal volume per kilogram of body weight (VT/kg) showed no significant difference between the RDS and non-RDS groups, while the RDS group had significantly higher ratio of time to peak tidal expiratory flow to total expiratory time (tPTEF/tE) and ratio of volume to peak tidal expiratory flow to total expiratory volume (vPTEF/vE) than the non-RDS group of the same gestational age (P < 0.05). At a corrected gestational age of 44 weeks, the two groups of neonates with varying severity levels of RDS had significantly lower tPTEF/tE and vPTEF/vE than the control group (P < 0.05), and tPTEF/tE and vPTEF/vE tended to decrease with the increasing severity level of RDS. Conclusions Neonates with RDS have significantly decreased pulmonary function than those without RDS. At a corrected gestational age of 44 weeks, the tidal breathing pulmonary function in neonates with RDS is not associated with gestational age, but is associated with the severity of RDS.
Respiratory distress syndrome / Tidal breathing pulmonary function / Premature infant
[1] Rocha G,Rodrigues M,Guimarães H.Respiratory distress syndrome of the preterm neonate--placenta and necropsy as witnesses[J].J Matern Fetal Neonatal Med,2011,24(1):148-151.
[2] 唐烁.新生儿呼吸窘迫综合征的临床分析[D].重庆:重庆医科大学,2013:9-18.
[3] 陆敏,车大钿,王爱莲,等.新生儿机械通气后远期肺功能随访[J].实用儿科临床杂志,2004,19(4):264-266.
[4] 张皓,邬宇芬,黄剑峰,等.儿童肺功能检测及评估专家共识[J].临床儿科杂志,2014,32(2):104-114.
[5] 饶小春,刘玺诚,焦安夏,等.应用体描仪检测婴幼儿肺功能[J].中华医学杂志,2009,89(34):2432-2434.
[6] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2011:395-398.
[7] 贺湘玲,张兵,尤胜,等.剖宫产儿早期潮气呼吸肺功能的研究[J].中国当代儿科杂志,2005,7(5):411-413.
[8] Kramer BW.The respiratory distress syndrome (RDS) in preterm infants[J].Intensivmedizin und Notfallmedizin,2007,44:403-408.
[9] Kennedy JD.Lung function outcome in children of premature birth[J].J Paediatr Child Health,1999,35(6):516-521.
[10] 黄小霏,高平明,林露.新生儿呼吸窘迫综合征治疗后肺功能的随访研究[J].国际医药卫生导报,2006,12(15):28-30.
[11] 张皓,孙波,任慈芳,等.婴幼儿肺炎治疗前后潮气呼吸肺功能指标的变化[J].中国当代儿科杂志,2001,3(4):384-386.
[12] Kotecha SJ,Dunstan FD,Kotecha S.Long term respiratory outcomes of late preterm-born infants[J].Semin Fetal Neonatal Med,2012,17(2):77-81.
[13] 齐利峰,余加林,刘晓红,等.不同胎龄新生儿肺功能动态监测[J].中华医学杂志,2013,93(24):1886-1890.
[14] 白琼丹.不同胎龄与不同分级新生儿呼吸窘迫综合征的临床分析[D].郑州:郑州大学,2012:17-39.
[15] 张亚平,张皓,邵肖梅.新生儿期机械通气对日后肺功能的影响[J].中国新生儿科杂志,2002,17(6):279-282.
[16] Jobe AJ.The new BPD:an arrest of lung development[J].Pediatr Res,1999,46(6):641-643.
[17] 陈朝红,张敏,王文明,等.校正胎龄40周时早产儿潮气呼吸肺功能研究[J].中国新生儿科杂志,2012,27(3):165-168.
[18] Stahlman M,Hedvall G,Lindstrom D,et al.Role of hyaline membrane disease in production of later childhood lung abnormalities[J].Pediatrics,1982,69(5):572-576.