支气管肺发育不良早产儿不同阶段肺功能情况研究

Pulmonary Function of Premature Infants with Bronchopulmonary Dysplasia at Different Stages

目的探讨支气管肺发育不良(BPD)早产儿不同阶段(出生后7 d、28 d、1年、2年)肺功能情况。方法选取2018年3月至2019年11月南京医科大学附属淮安第一医院收治的BPD早产儿91例为研究组,另选取同期南京医科大学附属淮安第一医院收治的非BPD早产儿87例为对照组。对所有患儿进行随访,记录其出生后7 d、28 d、1年、2年肺功能指标,包括呼吸频率(RR)、潮气量(TV)、潮气呼气峰流量(PTEF)、吸气时间/总呼吸时间(Ti/Tt)、达峰时间比(TPTEF/TE)、25%潮气量呼气流量(TEF_(25))、50%潮气量呼气流量(TEF_(50))、75%潮气量呼气流量(TEF_(75))。结果出生后1年,对照组有4例失访,研究组有3例失访;出生后2年,对照组有8例失访,研究组有7例失访;最终对照组有79例、研究组有84例完成随访。方法与时间在RR、TV、PTEF、Ti/Tt、TPTEF/TE、TEF_(25)、TEF_(50)、TEF_(75)上存在交互作用(P<0.05);方法、时间在RR、TV、PTEF、Ti/Tt、TPTEF/TE、TEF_(25)、TEF_(50)、TEF_(75)上主效应显著(P<0.05)。研究组出生后7 d、28 d、1年RR快于对照组,TPTEF/TE低于对照组(P<0.05);研究组出生后2年RR慢于对照组(P<0.05);研究组出生后7 d、28 d TV、PTEF、TEF_(25)、TEF_(50)、TEF_(75)低于对照组,Ti/Tt高于对照组(P<0.05)。两组出生后28 d、1年、2年RR分别慢于本组出生后7 d,TV、PTEF、TEF_(25)、TEF_(50)、TEF_(75)分别高于本组出生后7 d,Ti/Tt分别低于本组出生后7 d(P<0.05);两组出生后1年、2年RR分别慢于本组出生后28 d,TV、PTEF、TEF_(25)、TEF_(50)、TEF_(75)分别高于本组出生后28 d,Ti/Tt分别低于本组出生后28 d(P<0.05);两组出生后2年RR分别慢于本组出生后1年,TV、PTEF、TEF_(25)、TEF_(50)分别高于本组出生后1年(P<0.05);两组出生后1年、2年TPTEF/TE分别高于本组出生后7 d、28 d(P<0.05)。结论BPD早产儿新生儿期肺功能异常,婴儿期、幼儿期肺功能有所改善,但呼吸效率仍较低,动态监测BPD早产儿不同阶段肺功能指标可评估其肺发育情况,进而有利于对其进行对症治疗。

Objective To investigate the pulmonary function of premature infants with bronchopulmonary dysplasia(BPD)at different stages(7 days,28 days,1 year,and 2 years after birth).Methods A total of 91 premature infants with BPD admitted to the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University from March 2018 to November 2019 were selected as the study group.Another 87 non-BPD premature infants admitted to the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University during the same period were selected as the control group.All the children were followed up,and their pulmonary function indexes at 7 d,28 d,1 year and 2 years after birth were recorded,including respiratory rate(RR),tidal volume(TV),peak tidal expiratory flow(PTEF),inspiratory time/total breathing time(Ti/Tt),ratio of time to peak tidal expiratory flow to total expiratory time(TPTEF/TE),tidal expiratory flow at 25%tidal volume(TEF_(25)),tidal expiratory flow at 50%tidal volume(TEF_(50)),tidal expiratory flow at 75%tidal volume(TEF_(75)).Results At 1 year after birth,4 cases in the control group and 3 cases in the study group were lost to follow-up.At 2 years after birth,8 cases in the control group and 7 cases in the study group were lost to follow-up.There were 79 cases in the control group,84 cases in the study group completed the follow-up in the end.There was an interaction between method and time on RR,TV,PTEF,Ti/Tt,TPTEF/TE,TEF_(25),TEF_(50),and TEF_(75)(P<0.05);method and time had significant main effects on RR,TV,PTEF,Ti/Tt,TPTEF/TE,TEF_(25),TEF_(50),and TEF_(75)(P<0.05).The RR of the study group at 7 days,28 days and 1 year after birth was faster than that of the control group,and the TPTEF/TE was lower than that of the control group(P<0.05).The RR at 2 years after birth of the study group was slower than that of the control group(P<0.05);the TV,PTEF,TEF_(25),TEF_(50),and TEF_(75) at 7 days and 28 days after birth in the study group were lower than those in the control group,and Ti/Tt was higher than that in the control group(P<0.05).The RR at 28 days,1 year,and 2 years after birth in the two groups was slower than that at 7 days after birth,TV,PTEF,TEF_(25),TEF_(50),and TEF_(75) were higher than those at 7 days after birth,and Ti/Tt was lower than that at 7 days after birth,respectively(P<0.05);the RR of the two groups at 1 year and 2 years after birth was slower than that at 28 days after birth,TV,PTEF,TEF_(25),TEF_(50),and TEF_(75) were higher than those at 28 days after birth,and Ti/Tt was lower than that at 28 days after birth,respectively(P<0.05);the RR at 2 years after birth in the two groups was slower than that at 1 year after birth,and the TV,PTEF,TEF_(25),and TEF_(50) were higher than those at 1 year after birth,respectively(P<0.05);the TPTEF/TE at 1 year and 2 years after birth in the two groups were higher than those at 7 days and 28 days after birth,respectively(P<0.05).Conclusion Pulmonary function of BPD premature infants is abnormal in the neonatal period,and the pulmonary function in infancy and early childhood has improved,but the respiratory efficiency is still low.Dynamic monitoring of pulmonary function indicators in different stages of premature infants with BPD can evaluate their lung development,which is helpful for symptomatic treatment.