晚期早产儿与足月新生儿的潮气呼吸肺功能特点及其影响因素分析

Tidal breathing pulmonary function of late preterm and full-term neonates and its influencing factors

目的对比研究晚期早产儿与足月新生儿的潮气呼吸肺功能特点,以探讨影响新生儿呼吸系统发育水平的相关因素。方法选择2019年5月-2020年12月福建医科大学附属第一医院新生儿科收治的140例晚期早产儿(出生时胎龄34~36^(+6)周)和足月新生儿(出生时胎龄37~41^(+6)周)作为研究对象。所有新生儿出生后第7天,使用Jaeger MasterScreen设备进行新生儿肺功能检测。记录新生儿的一般资料和相关实验室指标,以及新生儿的潮气呼吸肺功能观察指标,包括潮气量(tidal volume,TV)、每公斤体重潮气量(tidal volume/kilogram,TV/kg)、分钟通气量(minute ventilation,MV)、达峰时间比(ratio of time to peak tidal expiratory flow to total expiratory time,TPTEF/TE)、达峰容积比(ratio of volume to peak tidal expiratory flow to total expiratory volume,VPTEF/VE)、呼气中期流速与吸气中期流速比(ratio of the expiratory to the inspiratory flow rate when exhaling and inhaling 50%of the tidal breath volume,TEF50/TIF50)。结果140例新生儿中,晚期早产儿31例(男20例、女11例),胎龄(35.54±0.89)周,出生体重(2.52±0.46)kg;足月新生儿109例(男65例、女44例),胎龄(39.26±1.10)周,出生体重(3.32±0.44)kg。晚期早产儿的TV、MV均显著低于足月新生儿(P值均<0.01),而两组间TV/kg、VPTEF/VE、TPTEF/TE、TEF50/TIF50的差异均无统计学意义(P值均>0.05)。身长≥50 cm、校正胎龄≥37周、出生时体重3.0~3.5 kg和>3.5 kg、检查时体重3.0~3.5 kg和>3.5 kg、血清白蛋白30~35 g/L和>35 g/L的新生儿TV和MV均显著高于身长<50 cm、校正胎龄<37周、出生时体重<3.0 kg、检查时体重<3.0 kg、血清白蛋白<30 g/L的新生儿(P值均<0.01)。其他变量亚组间TV和MV的差异均无统计学意义(P值均>0.05)。将单因素分析中差异有统计学意义的因素作为自变量,分别以TV、MV为因变量,进行多元线性回归分析。结果显示,检查时体重和校正胎龄均是新生儿TV、MV变化的影响因素(P值均<0.05),而非身长、出生体重和血清白蛋白水平(P值均>0.05)。结论检查时体重、校正胎龄是影响新生儿肺功能发育的相关因素,临床医师和新生儿家长应密切关注新生儿尤其是早产儿的生长发育情况,这对提升新生儿肺发育水平具有重要意义。

Objective To compare the tidal breathing pulmonary function between late preterm and full-term neonates and its influencing factors.Methods A total of 140 late preterm or full-term neonates admitted to the First Affiliated Hospital of Fujian Medical University from May 2019 to December 2020 were selected as research objects.Pulmonary function was examined by Jaeger MasterScreen device on day 7 after birth.General information,laboratory indicators,and indicators of tidal breathing lung function,such as tidal volume(TV),tidal volume/kilogram(TV/kg),minute ventilation(MV),ratio of time to peak tidal expiratory flow to total expiratory time(TPTEF/TE),ratio of volume to peak tidal expiratory flow to total expiratory volume(VPTEF/VE),and ratio of the expiratory to the inspiratory flow rate when exhaling and inhaling 50%of the tidal breath volume(TEF50/TIF50)were recorded.Results There were 31 late preterm neonates(20 males and 11 females)with a gestational age of(35.54±0.89)weeks and a birth weight of(2.52±0.46)kg and 109 full-term newborns(65 males and 44 females)with a gestational age of(39.26±1.10)weeks and a birth weight of(3.32±0.44)kg.The late preterm neonates had lower TV and MV than full-term neonates(both P<0.01).There were no significant differences in TV/kg,TPTEF/TE,VPTEF/VE or TEF50/TIF50 between the late preterm or full-term neonates(all P>0.05).Newborns with a body length≥50 cm,corrected gestational age≥37 weeks,birth weight of 3.0—3.5 kg and>3.5 kg,weight at examination of 3.0—3.5 kg and>3.5 kg,and serum albumin of 30—35 g/L and>35 g/L had significantly higher TV and MV than newborns with a body length<50 cm,corrected gestational age<37 weeks,birth weight<3.0 kg,weight at examination<3.0 kg,and serum albumin of 30—30 g/L(all P<0.01).There were no significant differences in TV or MV between subgroups of neonates with other variable(all P>0.05).Multivariate linear regression analysis was performed with statistically significant factors in univariate analysis as independent variables and TV and MV as dependent variables.And the result showed TV and MV were affected by weight at examination and corrected gestational age in neonates(both P<0.05),but body length,birth weight and serum albumin were not factors influencing TV and MV(all P>0.05).Conclusion Weight at examination and corrected gestational age were related factors affecting the development of neonatal pulmonary function.The growth and development of newborns should be paid more attention,especially preterm infants,which is of great significance for improving neonatal lung function.