摘要
背景:目前对于肺发育不全的诊断多基于尸检报告,临床上没有明确的诊断标准用于对该病的识别及处理。目的:通过描述胎膜早破后肺发育不全综合征(PHS)的呼吸系统状态的特点,以协助建立其临床的诊断标准。研究设计:对6例患有典型PHS的患儿及6例患有湿肺综合征(WLS)患儿的呼吸系统特点进行回顾性对比。研究对象:PHS及WLS患儿是由6年中进入新生儿三级护理单元的1094例患儿中选出的,选择标准建立在围生期纪录、呼吸系统表现、X线片、实验室检查结果及呼吸机的基础上。结果测量参数:进行对比的参数包括:由胸片上肺的大小计算得的肺容量系数(LVI), 通气系数(VI),通气效率系数(VEI),对人工表面活性剂的反应及供氧天数。结果:相对于WLS患儿而言, PHS患儿的LVI较低(4.5±0.5 vs 9.5±1.5,P【 0.01),VI较高(0.108±0.030 vs 0.022±0.005,P【 0.05),VEI较低(0.083±0.012 vs 0.258±0.052,P【 0.01)。有4例PHS患儿应用了人工表面活性剂,但呼吸系统功能都没有得到改善。3例存活的PHS患儿的供氧天数为11-79 d,而WLS患儿的为2-14 d。结论:该研究表明低的LVI(【6.5)和VEI(【0.15)对诊断PHS 最有意义。
Background: At present, the diagnosis of pulmonary hy-poplasia is based on postmortem findings, and there are no clear clinical diagnostic criteria to facilitate its identification and management. Aim: To characterise the respiratory status of pulmonary hypoplasia syndrome (PHS) following preterm rupture of membranes so as to establish its clinical diagnostic criteria. Study design: Retrospective comparison of respiratory characteristics of six typical PHS infants with six wet lung syndrome (WLS) infants who served as controls. Subjects: The PHS and WLS infants were selected from 1094 patients admitted to a tertiary care neonatal unit over a 6-year period, with criteria based on perinatal history, respiratory signs, X-ray and laboratory findings, and ventilator settings. Outcome measures: The compared variables were lung volume index (LVI) calculated from lung dimensions on chest X-ray, ventilatory index (VI), ventilatory efficiency index (VEI), response to artificial surfactant treatment, and ventilation days. Results: In PHS compared to WLS infants, LVI was lower (4.5±0.5 vs. 9. 5±1.5; p< 0.01), Ⅵ was higher (0. 108±0.030 vs. 0.022±0.005; p<0.05), and VEI was lower (0. 083±0. 012 vs. 0. 258±0. 052; p < 0. 01) (mean±S. E. ). Artificial surfactant was given to four PHS infants, but none of them showed respiratory improvement. Ventilation days were 11 - 79 in three surviving PHS infants and 2-14 in WLS infants. Conclusions: In this preliminary study, low LVI ( < 6. 5) and VEI (< 0. 15) were the most useful indicators of PHS.
