极低出生体质量儿支气管肺发育不良潮气呼吸肺功能动态随访

Follow-up of tidal breathing lung function in very low birth weight preterm infants with bronchopulmonary dysplasia

目的对发展为支气管肺发育不良(BPD)的极低出生体质量儿进行潮气呼吸肺功能的动态随访,阐述BPD对肺功能的影响。方法选取2017年2月至2018年2月入住温州市中西医结合医院新生儿科的极低出生体质量早产儿236例为研究对象,依据是否发展为BPD将其分为BPD组(以程度再分为轻度组、中度组和重度组)与非BPD组,在出院前1周及校正胎龄3个月时对其进行潮气呼吸肺功能测定,记录相关指标并进行比较分析。结果第1次测量潮气呼吸肺功能显示呼吸峰流速(PTEF),75%、50%、25%潮气量时呼气流速(TEF75、TEF50、TEF25),重度BPD组高于其余各组,而非BPD组及中度BPD组高于轻度BPD组(F值分别为27.250、52.295、12.152、38.968,均P<0.05);呼吸频率(RR)的中、重度组较其余组快(F=29.292,P<0.05);达峰容积比(VPEF/VE)、达峰时间比(TPEF/tE)随着BPD严重程度而明显下降(F值分别为38.968、37.262,均P<0.05)。第2次测量潮气呼吸肺功能显示PTEF、TEF75、TEF50、TEF25,重度BPD组高于其余各组(F值分别为14.891、17.874、4.635、3.873,均P<0.05),VPEF/VE、TPEF/tE重度BPD组低于其余各组(F值分别为7.569、11.615,均P<0.05),而其余指标各组间比较差异均无统计学意义(均P>0.05)。第1次和第2次测定,各组间潮气量(VT)比较差异均无统计学意义(F值分别为0.861、1.890,均P>0.05)。结论发展为BPD的患儿肺功能明显低下,但随日龄增长(体质量增长),部分肺功能得到修复,但肺损伤程度严重的患儿小气道阻塞仍不能得到完全改善。因此,临床救治早产儿过程中积极预防BPD发生,对婴幼儿时期甚至是青春期后的呼吸道疾病预防及治疗方面可能有重要意义。

Objective To carry out follow-up of tidal breathing lung function in very low birth weight infants who developed bronchopulmonary dysplasia(BPD)and explore its influence on BPD.Methods Altogether 236 cases of very low birth weight preterm infants who were hospitalized in Department of Neonatology of Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from February 2017 to February 2018 were enrolled as study objects,and they were divided into BPD group(subdivided into mild group,moderate group and severe group based on degree of severity)and non BPD group according to whether developing BPD.Tidal breathing lung function was measured at 1 week before discharge and 3 months of corrected gestational age.Related indexes were recorded and compared.Results The first measurement of tidal breathing lung function showed that peak tidal expiratory flow(PTEF),tidal expiratory flow at 75%,50%,25%tidal volume(TEF75,TEF50,TEF25)were higher in severe BPD group than in other groups(P<0.05),while those in non-BPD group and moderate BPD group were higher than those in mild BPD group(F value was 27.250,52.295,12.152 and 38.968,respectively,all P<0.05).Respiratory frequency(RR)in moderate and severe groups was higher than that in other groups(F=29.292,P<0.05).Ratio of volume to peak tidal expiratory flow and total expiratory volume(VPEF/VE),ratio of time to peak tidal expiratory flow and total expiratory time(TPEF/TE)were all significantly decreased with severity of BPD(F value was 38.968 and 37.262,respectively,both P<0.05).Second measurement of tidal breathing lung function showed that levels of PTEF,TEF75,TEF50,TEF25 in severe BPD group were higher than those in other groups(F value was 14.891,17.874,4.635 and 3.873,respectively,all P<0.05),but VPEF/VE and TPEF/tE in severe BPD group were lower than in other groups(Fvalue was 7.569 and 11.615,respectively,both P<0.05).There was no significant difference in other indicators among each group(all P >0.05).There was no significant difference in tidal volume(VT)in first and second measurements among groups(Fvalue was 0.861 and 1.890,respectively,both P>0.05).Conclusion Lung function of BPD infants is significantly lower than that of non-BPD infants,but with increase of age(body weight),partial lung function can be repaired.However,small airway obstruction in infants with severe lung injury can not be completely improved.Therefore,prevention of BPD in clinical treatment of premature infants is of great significance to prevent and treat respiratory diseases in their childhood and even adolescence.