晚期早产儿校正胎龄足月时潮气呼吸肺功能的观察

Observation of pulmonary function of tidal respiration in late preterm infants at corrected gestational age of full term

目的：初步探讨未接受机械通气的晚期早产儿在校正胎龄足月时潮气呼吸肺功能的情况。方法收集2013年4月至2013年12月在青岛市妇女儿童医院住院,且出院时校正胎龄达足月的未接受过机械通气的晚期早产儿（26例）,为晚期早产儿组；以同期因高胆红素血症或新生儿ABO溶血症住院的足月儿为足月儿组（31例）；比较两组患儿潮气呼吸肺功能各项指标的差异。其中根据生后体重增长情况进一步将晚期早产儿分为宫外发育迟缓组（13例）与非宫外发育迟缓组（13例）,比较两组的达峰时间比（ ratio of time to peak tidal expiratory flow and total expiratory time,TPEF/TE）、达峰容积比（ ratio of expiratory volume at peak tidal expiratory flow and total expiratory volume,VPEF/VE）有无差异；并进行非宫外发育迟缓组患儿出生体重与TPEF/TE的相关性分析。结果（1）晚期早产儿组和足月儿组在监测潮气呼吸肺功能时的胎龄差异无统计学意义（ P＆gt;0．05）；晚期早产儿组在校正胎龄足月时体重[（2．39±0．44） kg vs．（3．21±0．43） kg]、身长[（46．51±3．22） cm vs．（50．16±2．14） cm]仍落后于足月儿组,差异有统计学意义（P均＆lt;0．05）。（2）晚期早产儿组、足月儿组潮气呼吸肺功能各项指标的比较：晚期早产儿组的TPEF/TE[（41．74±10．94）% vs．（48．17±11．79）%]、VPEF/VE[（42．66±9．66）% vs．（48．31±9．94）%]、达峰容积[（8．02±2．85） ml vs．（10．23±3．56） ml]、每分通气量[（0．76±0．23） L/min vs．（1．00±0．44） L/min]明显低于足月儿组,差异有统计学意义（P均＆lt;0．05）。（3）足月儿组、晚期早产儿组的TPEF/TE与VPEF/VE均有相关性（足月儿组：r=0．950,P=0．000；晚期早产儿组：r=0．958,P=0．000）。（4）晚期早产儿非宫外发育迟缓组的TPEF/TE、VPEF/VE更接近足月儿组,宫外发育迟缓组TPEF/TE、VPEF/VE均较非宫外发育迟缓组低,且差异有统计学意义（ t=-2．775,-2．109,P=0．011,0．047）。结论未接受机械通气的晚期早产儿在校正胎龄足月时气道（尤其是小气道）的阻力仍高于足月儿。宫外发育迟缓对晚期早产儿的气道阻力有影响。

Objective To investigate pulmonary function of tidal respiration in late premature infants with non-mechanical ventilation treatment at corrected gestational age of full term. Methods A total of 26 late premature infants with non-mechanical ventilation treatment at corrected gestational age of full term were collected from Qingdao Women and Children′s Hospital between April and December 2013,and saved as the late premature infant group. Also, a total of 31 full term infants with hyperbilirubinemia or neonatal ABO hemolytic disease were recruited and treated as the full term group. Then the parameters of pulmonary function of tidal respiration were compared between the two groups. The late premature infant group was equally allocated into extrauterine growth retardation and non-extrauterine growth retardation groups according to the increase in weight and the ratio of time to peak tidal expiratory flow and total expiratory time（TPEF/TE） and the ratio of expiratory volume at peak tidal expiratory flow and total expiratory volume（ VPEF/VE） were respectively compared in these two groups. Another correlation analysis between body weight and TPEF/TE was carried out in the non-extrauterine growth retardation group. Results （1）Gestational age difference had no significant significance between late premature infant group and full term group （ P 〈0. 05 ） . The body weight[（2. 39 ± 0. 44）kg vs. （3. 21 ± 0. 43） kg] and height[（46. 51 ± 3. 22） cm vs. （50. 16 ± 2. 14） cm] in late premature infant group were still lag behind that in full term group and the difference had significant significance（P〈0. 05,respectively）. （2）The comparison of parameters of pulmonary function of tidal respi-ration：the TPEF/TE [ （ 41. 74 ± 10. 94 ）% vs. （ 48. 17 ± 11. 79 ）%] , VPEF/VE [ （ 42. 66 ± 9. 66 ）% vs. （48. 31 ± 9. 94）%],VPEF[（8. 02 ± 2. 85） ml vs. （10. 23 ± 3. 56） ml] and minute ventilation[（0. 76 ± 0. 23） L/min vs. （1. 00 ± 0. 44） L/min] in late premature infant group were significantly lower than those in full term group（P〈0. 05,respectively）. （3）The TPEF/TE and VPEF/VE all had significant significance in both late premature infant group and full term group（late premature infant group：r=0. 958,P=0. 000; full term group：r=0. 950,P=0. 000）. （4）The TPEF/TE and VPEF/VE in non-extrauterine growth retardation group were closer to those in full term group. The TPEF/TE and VPEF/VE in extrauterine growth retardation group were lower than those in non-extrauterine growth retardation group（t= -2. 775,-2. 109,P=0. 011, 0. 047）. Conclusion Airway（especially small airway） resistance of late preterm infant group is higher than that of term infants. Extrauterine growth retardation influences the airway（especially small airway） resistance.