绒毛膜羊膜炎和脐带炎与早产儿肺部损伤的关系研究

Are chorioamnionitis and funisitis associated with lung injury or pulmonary function of premature infants？

目的探讨绒毛膜羊膜炎（histological chorioamnionitis，HCA）和脐带炎（funisitis，FV）与早产儿肺部损伤的相关性。方法回顾性选取2015年10月至2016年8月在青岛市妇女儿童医院产科分娩并收入新生儿科的胎龄〈34周早产儿，根据胎盘病理结果分为无感染组、单纯HCA组和HCA＋FV组。比较各组早产儿一般情况、感染指标、呼吸支持时间、氧合参数及校正胎龄40周时潮气肺功能的差异。结果无感染组33例，单纯HCA组61例，HCA＋FV组57例。HCA＋FV组无创通气时间和过渡到吸入空气时间[M（Q1，Q3）]长于无感染组[0（0，66） h比0（0，0） h，65（0，176） h比0（0，8） h]，有创通气时间和总通气时间[M（Q1，Q3）]长于无感染组和单纯HCA组[0（0，4） h比0（0，0）、0（0，0） h，0（0，99） h比0（0，0）、0（0，52） h]，差异有统计学意义（P〈0.05）。各组开始呼吸支持后0.5 h氧分压差异无统计学意义（P〉0.05）。患儿校正胎龄40周时达峰时间比、达峰容积比、达峰时间、达峰容积等肺功能指标均随炎症程度加重逐渐降低，但各组比较差异均无统计学意义（P〉0.05）。结论HCA和FV与早产儿肺部损伤关系密切，胎盘炎症程度越重，早产儿呼吸支持时间越长，但HCA和FV对肺功能可能无明显影响。

ObjectiveTo investigate the relationship between histological chorioamnionitis （HCA）, funisitis （FV） and lung injury in preterm infants. MethodData of preterm infants with gestational age of less than 34 weeks, who were born in our Hospital and admitted to the neonatal ward during the period of October 2015 to August 2016 were retrospectively collected. According to reports of placenta pathologies, participants were assigned into three groups, non-infection group, HCA group and HCA＋ FV group. Demographic and infectious characteristics, duration of respiratory support, partial pressure of oxygen （PaO2） and pulmonary function testing results at corrected gestational age 40 weeks were compared among groups.ResultA total of 151 preterm infants were included, with 33 cases in non-infection group, 61 cases in HCA group and 57 cases in HCA＋ FV group. Non-invasive ventilation duration and number of days in room air in HCA＋ FV groups were both longer than those in the non-infection group [0 （0, 66） h vs.0 （0, 0） h, 65 （0, 176） h vs.0 （0, 8） h]. The duration of invasive ventilation and total ventilation days in HCA＋ FV group were longer than those of the other two groups [0 （0, 4） h vs.0 （0, 0） and 0 （0, 0） h, 0 （0, 99） h vs.0 （0, 0） and 0 （0, 52） h], the differences were statistically significant （P〈0.05）. However, there was no significant difference of PaO2 after 0.5 hour respiratory support among the three groups （P〉0.05）. Pulmonary functional parameters, such as respiratory frequency, VPEF/TE, VPEF/VE, VPEF and TPEF, gradually decreased with the degree of inflammatory progress, but there was no statistically significant difference （P〉0.05）.ConclusionHCA and FV are highly associated with premature lung injury. The worse the placental inflammation is, the longer respiratory support duration will be needed or required. However, HCA and FV may have no significant effect on lung function.