发生支气管肺发育不良早产儿血流动力学改变的动态监测

Dynamic monitoring of the change in hemodynamics in preterm infants developing bronchopulmonary dysplasia

目的:研究发生支气管肺发育不良(bronchopulmonary dysplasia,BPD)早产儿血流动力学的改变及其意义。方法:依据BPD的诊断及分度标准,将符合纳入标准的59例早产儿分成非BPD组(n=27)、轻度BPD组(n=9)、中度BPD组(n=13)、重度BPD组(n=10),分别于生后第1、7、28 d采用无创心输出量测量仪进行血流动力学参数的动态监测,并分析参数与发生BPD患儿生后28 d血浆B型脑钠肽(brain natriuretic peptide,BNP)浓度的相关性。结果:与非BPD组比较,BPD各组在生后7、28 d心输出量/心脏指数(cardiac output/index,CO/CI)值均降低,差异具有统计学意义(P<0.05);与轻度、中度BPD组比较,重度BPD组在生后1、7 d、28 d的CO/CI值均降低,差异具有统计学意义(P<0.05),其余各组在各时点CO/CI值比较,差异无统计学意义(P>0.05)。与非BPD组比较,BPD各组在生后1、28 d每搏输出量/每搏输出指数(stroke volume/index,SV/SI)均降低,差异具有统计学意义(P<0.05);与轻度、中度BPD组比较,重度BPD组的SV/SI值在生后1、7、28 d均降低,差异具有统计学意义(P<0.05),其余各组在各时点SV/SI值比较,差异无统计学意义(P>0.05)。与非BPD组、轻度及中度BPD组比较,重度BPD组在生后7、28 d的左室射血时间(left ventricular ejection time,LVET)值均降低,差异具有统计学意义(P<0.05),其余各组在各时点LVET值比较,差异无统计学意义(P>0.05)。与非BPD组比较,在生后28 d,中、重度BPD组的收缩时间比例(systolic Time ratio,STR)增高,差异具有统计学意义(P<0.05),其余各组在各时点STR值比较,差异无统计学意义(P>0.05)。与非BPD组比较,BPD各组在生后1、14、28 d的心率(heart rate,HR)、胸腔液体水平(thoracic fluid content,TFC)、心肌收缩指数(index of contractility,ICON)值比较,差异无统计学意义(P>0.05)。与非BPD组,在生后28 d时BPD组的BNP浓度升高,差异具有统计学意义(P<0.05),且BNP浓度与第28 d的CO/CI值(r=-0.714,P<0.05)、SV/SI值(r=-0.4,P<0.05)的改变呈负相关,与STR值的改变呈正相关(r=0.722,P<0.05)。结论:早产儿发生支气管肺发育不良的过程中存在不同程度的血流动力学改变,进而出现心功能的改变;动态监测早产儿心排量参数变化有利于早期评估BPD患儿心功能改变情况。

Objective:To investigate the change in hemodynamics and its significance in preterm infants devel-oping bronchopulmonary dysplasia(BPD).Methods:According to the diagnostic and grading criteria for BPD,59 pre-term infants who met the inclusion criteria were divided into non-BPD group with 27 infants,mild BPD group with 9 infants,moderate BPD group with 13 infants,and severe BPD group with 10 infants.A noninvasive cardiac outputmonitor was used for dynamic monitoring of hemodynamic parameters on days 1,7,and 28 after birth,and the correlation of these parameters with brain natriuretic peptide(BNP)concentration on day 28 after birth was analyzed inpreterm infants developing BPD.Results:Compared with the non-BPD group,the three BPD groups had a signifi-cant reduction in cardiac output/cardiac index(CO/CI)on days 7 and 28 after birth(P<0.05),and compared withthe mild and moderate BPD groups,the severe BPD group had a significant reduction in CO/CI on days 1,7,and 28 after birth(P<0.05),while there was no significant difference in CO/CI between the above groups at the other timepoints(P>0.05).Compared with the non-BPD group,the three BPD groups had a significant reduction in stoke vol-ume/stoke index(SV/SI)on days 1 and 28 after birth(P<0.05),and compared with the mild and moderate BPDgroups,the severe BPD group had a significant reduction in SV/SI on days 1,7,and 28 after birth(P<0.05),whilethere was no significant difference in SV/SI between the above groups at the other time points(P>0.05).Comparedwith the non-BPD group,mild BPD group,and moderate BPD group,the severe BPD group had a significant reduc-tion in left ventricular ejection time(LVET)on days 7 and 28 after birth(P<0.05),while there was no significant dif-ference in LVET between the above groups at the other time points(P>0.05).Compared with the non-BPD group,the severe BPD group had a significant increase in systolic time ratio(STR)on day 28 after birth(P<0.05),whilethere was no significant difference in STR between the above groups at the other time points(P>0.05).There wereno significant differences in heart rate,thoracic fluid content,and contractility on days 1,14,and 28 after birth be-tween the non-BPD group and the three BPD groups(P>0.05).Compared with the non-BPD group,the BPD grouphad a significant increase in BNP concentration on day 28 after birth(P<0.05),and BNP concentration was nega-tively correlated with the changes in CO/CI(r=-0.714,P<0.05)and SV/SI(r=-0.4,P<0.05)on day 28 afterbirth and positively correlated with the change in STR(r=0.722,P<0.05).Conclusion:There are varying de-grees of hemodynamic changes in preterm infants during the development of BPD,which may lead to the change incardiac function.Dynamic monitoring of cardiac output parameters may help with early evaluation of cardiac func-tion changes in preterm infants with BPD.