潮气呼吸流速—容量环对支气管肺发育不良患儿肺功能的监测

发布时间：2017-12-30 17:52

  本文关键词：潮气呼吸流速—容量环对支气管肺发育不良患儿肺功能的监测　出处：《重庆医科大学》2013年硕士论文　论文类型：学位论文

  更多相关文章： 潮气呼吸流速-容量环 支气管肺发育不良 功能残气量 肺清除指数 早产儿

【摘要】：目的：探讨潮气呼吸流速-容量环（TBFVL）结合功能残气量（FRC）和肺清除指数（LCI）对支气管肺发育不良（BPD）患儿肺功能的监测作用。 方法：2011年1月-2012年10月在深圳市儿童医院新生儿科及新生儿重症监护病房住院及门诊随访的无严重心肺疾病的非BPD早产儿113例为非BPD早产儿组（对照组），BPD早产儿106例为观察组，根据BPD的分度标准分为轻、中、重三组（48例，42例，，16例）。在校正胎龄（PMA）44周各组进行潮气呼吸肺功能检测，各组患儿检测时无呼吸道症状。潮气呼吸肺功能指标包括TBFV环形态和参数数值及FRC、LCI数值，将各指标与BPD严重程度进行相关性分析，在校正胎龄76周时对各组患儿肺功能进行复查，分析各组TBFV环形态及数值变化。 结果：（1）TBFVL形态分析：BPD组呼气降支陡峭，PMA44周时轻度BPD组呼气降支斜率较非BPD早产儿组增大，中重度BPD组呼气降支明显向容量轴凹陷；重度BPD组TPEF、TPIF均明显增加。PMA76周时轻度BPD组呼气降支与非BPD早产儿组相似，均较平缓，中度BPD组呼气降支稍陡峭，重度BPD组呼气降支有凹陷；重度BPD组TPEF较其余各组明显升高。 （2）肺功能参数分析：PMA44周时中、重度BPD组RR、TPIF【分别为(56.79±8.91)、(58.11±10.12)次/min，(60.91±20.54)、(75.30±14.43)ml/s】比非BPD早产儿组【(49.91±12.78)次/min、(52.39±20.12)ml/s】高，P0.05，且重度BPD组TPIF比轻度BPD组TPIF高，P0.05，轻度BPD组RR、TPIF【分别为(52.97±12.59)次/min、(55.27±21.61)ml/s】与非BPD早产儿组无统计学差异，P0.05。中、重度BPD组Tpef/Te比非BPD早产儿组【(20.36%±9.15%)、(18.07%±5.28%)比(28.79%±9.06%)】低，P0.01，且重度BPD组Tpef/Te比轻度BPD组(24.29%±12.80%)低，P0.05，轻度BPD组Tpef/Te与非BPD早产儿组无统计学差异，P0.05。TPEF重度BPD组【(85.33±11.48)ml/s】比非BPD早产儿组、轻度BPD组【(58.55±23.09)、(56.03±24.93)ml/s】均高，均P0.05。TV各组间无统计学差异【分别为(24.80±9.14)、(23.37±8.78)、(22.17±8.67)和(22.05±3.36)ml，均P0.05】。中、重度BPD组FRC均比非BPD早产儿组【(15.37±3.14)、(15.06±3.85)比(19.96±5.04)ml/kg】低， P0.01，轻度BPD组【(17.74±5.47)ml/kg】FRC与非BPD早产儿组无统计学差异，P0.05；LCI则只有中度BPD组比非BPD早产儿组高【(9.93±3.34)比(8.36±2.78)】，P0.05。PMA76周时,轻、中、重BPD组Tpef/Te【20.80%±3.03%、18.07%±2.98%、16.73±2.50%】比非BPD早产儿组(36.06±5.06)低(P0.05)，LCI【(9.42±1.61)、(10.33±1.72)、(10.89±1.88)】比非BPD早产儿组(7.98±1.61)高(P0.05)，FRC除轻度BPD【(21.14±2.82)ml/kg】组外，中、重度BPD组【(19.26±2.16)、(19.19±2.15)ml/kg】均比非BPD早产儿组低(P0.05),除重度BPD组外，轻、中度BPD组潮气量【(71.40±6.32)、(70.14±8.60)ml】均低于非BPD早产儿组【(75.79±5.64) ml】(P0.05)，TPEF仍只有重度BPD组高于非BPD早产儿组【(162.90±16.50)比(133.70±21.62)ml/s，P0.05】，轻、中、重BPD组RR、TPIF均与非BPD早产儿组无统计学差异(P0.05)。 （3）两次测试结果比较：各组RR在PMA76周时比PMA44周时低【分别为非BPD早产儿组：(36.06±5.06)比(49.91±12.78)次/min，轻度BPD组：(36.50±6.79)比(52.97±12.59)次/min，中度BPD组：(37.05±5.70)比(56.79±8.91)次/min，重度BPD组：(38.61±6.17)比(58.11±10.12)次/min,均P0.05】，各组TPIF、TPEF和FRC在PMA76周时比PMA44周时高【非BPD早产儿组分别为(133.70±21.62)比(52.39±20.12)ml/s、(141.08±24.79)比(58.55±23.09)ml/s和(21.72±3.12)比(19.96±5.04)ml/kg；轻度BPD组分别为(129.33±17.25)比(55.27±21.61)ml/s、(147.02±22.28)比(56.03±24.93)ml/s和(21.14±2.82)比(17.74±5.47)ml/kg；中度BPD组分别为(126.52±19.73)比(60.91±20.54)ml/s、(149.87±22.24)比(69.59±33.17)ml/s,(19.26±2.16)比(15.37±3.14)ml/kg；重度BPD组分别为(124.53±20.62)比(75.30±14.43)ml/s，(162.90±16.50)比(85.33±11.48)ml/s和(19.19±2.15)比(15.06±3.85)ml/kg】，均P0.05；非BPD早产儿组、轻度BPD组、中度BPD组Tpef/Te在PMA76周时比PMA44周时低【分别为(23.17%±4.32%)比(28.79%±9.06%)、(20.80%±3.03%)比(24.29%±12.80%)和(18.07%±2.98%)比(20.36%±9.15%)】，P0.05，重度BPD组无明显差异【(16.73%±2.50%)比(18.07%±5.28%)，t=1.712，P=0.113】；各组LCI在PMA44周和PMA76周时无明显差异【分别为(7.98±1.61)比(8.36±2.78)、(9.42±1.61)比(9.01±3.22)、(10.33±1.88)比(9.93±3.34)和(10.89±1.88)比(10.31±2.85)，均P0.05】。 （4）各参数与BPD严重程度相关性分析：PMA44周时RR、Tpef/Te、TPEF、TPIF、TEF75、FRC与BPD严重程度明显相关(均P0.05),TV、LCI与BPD严重程度相关性不明显(均P0.05)。PMA76周时Tpef/Te、TEF75、FRC、LCI与BPD严重程度明显相关(均P0.05),RR、TV、TPIF、TPEF与BPD严重程度相关性不明显(均P0.05)。 结论：TBFVL可直观反映不同程度支气管肺发育不良患儿潮气呼吸肺功能特征。TBFVL结合FRC、LCI能较全面、系统的反映BPD患儿的大小气道、肺组织弹性的异常及随年龄增加肺发育恢复状况，可用于BPD患儿肺发育的监测。
[Abstract]:Objective: To investigate the tidal flow volume loop (TBFVL) combined with functional residual capacity (FRC) and lung clearance index (LCI) of bronchopulmonary dysplasia (BPD) monitoring of pulmonary function in children.
Methods: January 2011 October -2012 in newborn and pediatric Shenzhen city children's Hospital ICU inpatient and outpatient follow-up without serious heart and lung disease in preterm infants and 113 cases of non BPD non BPD preterm infants group (control group), BPD of 106 cases of the observation group, according to the standard of BPD is divided into light. Three group (48 cases, 42 cases, 16 cases). The corrected gestational age (PMA) 44 weeks of tidal breathing lung function test, serum detection without respiratory symptoms. Pulmonary function index including tidal pattern and parameters of TBFV ring and FRC LCI numerical value, the index and the severity of BPD through correlation analysis, review of lung function in children with groups in the corrected gestational age of 76 weeks, were analyzed for TBFV ring shape and numerical changes.
Results: (1) TBFVL morphological analysis: BPD group breath descending steep, mild BPD group at PMA44 weeks of expiratory slope than that in non BPD group increased in premature infants, severe BPD group breath descending significantly to the capacity of shaft sag; severe BPD group TPEF, TPIF were significantly increased at.PMA76 weeks of mild BPD group call drop gas with non BPD preterm infants were similar, is fairly gentle, moderate BPD group breath descending slightly steep, severe BPD group breath descending depression; severe BPD group TPEF was significantly increased compared with the rest of the group.
(2)鑲哄姛鑳藉弬鏁板垎鏋愶細PMA44鍛ㄦ椂涓

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