不同胎龄早产儿潮气呼吸肺功能的测定及分析

发布时间：2018-01-09 12:03

  本文关键词：不同胎龄早产儿潮气呼吸肺功能的测定及分析　出处：《郑州大学》2014年硕士论文　论文类型：学位论文

  更多相关文章： 肺功能 新生儿 早产 影响因素 随访

【摘要】：呼吸系统疾病是早产儿最常见的疾病之一，也是其重要发病和死亡原因，近年来其患病率一直居高不下。随着围生医学的快速发展及医疗水平的不断提高，我国早产儿（premature infant,PI）发生率已上升至8.1%，早产儿的存活率也明显提高。由于其肺部发育不完善、体重低下、免疫力低下等因素，极易出现呼吸系统疾病，越来越多的临床研究表明早产儿呼吸系统疾病的发病率在逐年增加，因其住院时间较长，花费高，给家庭、社会带来巨大的心理负担和经济负担，近年来引起社会的高度关注。 肺功能检查不仅能用于鉴别呼吸系统疾病的性质、判断疾病的严重程度，在评价药物治疗效果及协助呼吸机参数的选择上也起到至关重要的作用，已成为预测疾病及监控病情的重要组成部分，广泛应用于呼吸内科，儿科，妇产科，胸外科，职业病评定等多个领域。肺功能各参数的正常值在诊治疾病、判断疗效中起到不可或缺的参考作用。常规的肺功能测定需要患者的积极配合，这限制了其在儿童以及在新生儿的应用。而检查潮气呼吸肺功能仅需平静呼吸，因此适用于新生儿。新生儿肺功能检测从上世纪50年代开始出现于临床，由于检测技术落后、新生儿潮气量小、检测结果准确度差等原因使其未能顺利开展。随着计算机的快速发展，临床已开始广泛开展新生儿肺功能的研究，但目前国内对早产儿肺功能的研究仍较少，而且缺乏早产儿肺功能的随机对照研究。 目的 通过对住院期间无呼吸系统疾病的不同胎龄早产儿动态进行肺功能检测，了解其生后早期潮气呼吸肺功能及重要呼吸参数的特点；对出院后的早产儿进行随访，探讨其校正胎龄40周时潮气呼吸肺功能及重要呼吸参数的变化，比较其与对照组肺功能之间的差异，并对其影响因素进行分析，以提高临床医师对早产儿肺功能的认识，并提供临床正常参考值。 方法 1研究对象分组 研究对象来源于2013年2月至2013年10月在郑州大学第三附属医院新生儿科住院的75例早产儿（premature infant,PI），均为适于胎龄儿，剖宫产出生，出生时Apgar评分7分；选择同期收住的足月儿（term infant,TI）55例为对照组，剖宫产出生，胎龄（gestational age，GA）39~40周。 排除标准：1.受试时有呼吸窘迫等呼吸道症状；2.母亲有吸烟史；3.一级亲属中有哮喘史；4.存在对肺功能有影响的先天性疾病；5.受试前曾应用对肺功能有影响的药物。2方法 本次研究选用潮气呼吸法，在新生儿药物睡眠（药物选用5％水合氯醛0.5～0.8ml／kg灌肠或口服）或者自然睡眠、平静呼吸的状态下，将面罩扣紧于患儿口鼻，通过流速传感器把流速信号积分成容量，电脑可显示出测得值。测定前常规记录新生儿的胎龄、性别，测量其身长及体质量，实验组和对照组在生后3-5天分别测定其潮气呼吸肺功能。每人测试3次，由电脑自动计算其平均值。可测定的主要参数有：潮气量(Tidal volume,VT)、每公斤体重潮气量(Tidalvolume/kg,VT/kg)、吸气时间(Inspiratory time,tI)、呼气时间(Expiratory time,tE)、吸呼比(Ratio tI to tE,tI/tE)、呼吸频率(Respiratory rate,RR)、达峰时间(Time toPTEF,TPEF)、达峰时间比(Ratio of TPEF and total tE,TPEF/tE)、达峰容积(Expiratory volume at PTEF,VPEF)、达峰容积比(Ratio of VPEF and totalVE,VPEF/VE）。 对实验组进行随访，校正胎龄40周时对其再次进行潮气呼吸肺功能的测定，，采用统计学方法进行分析，探讨不同胎龄早产儿生后早期及校正胎龄40周时主要呼吸参数的变化及影响因素，并比较其与足月儿肺功能之间的差异。 结果 1.生后3-5天时各组之间肺功能主要参数的差异 p1组及p2组的胎龄较小，出生体质量低，肺部发育不完善，TPEF、TPEF/tE、VPEF、VPEF/VE值均明显低于TI组，RR值则高于TI组（均P0.05）；p3组与TI组除tI、TPEF、TPEF/tE以外，其余肺功能参数的差异无统计学意义（P0.05）；p1组与p3组相比，tI、TPEF、TPEF/tE、VPEF、VPEF/VE及RR值的差异有统计学意义（P0.05）；p1组与p2组相比，TPEF、TPEF/tE、VPEF及VPEF/VE的差异有统计学意义（P0.05）；p2组除RR、tI及TPEF外，其余肺功能参数与p3组相比差异无统计学意义（P0.05）。 2.早产儿校正胎龄40周时各组之间肺功能参数的差异 与TI组相比较，p1组校正胎龄40周时TPEF/tE、VPEF/VE、TPEF、VPEF均明显低于TI组，RR明显高于TI组（均P0.05），p2组TPEF/tE、VPEF/VE、TPEF、VPEF均明显低于TI组（P0.05），其它指标差异不具有显著性，p3组与TI组相比较，仅表现为TPEF、TPEF/tE低于TI组（P0.05），其余肺功能参数的差异均无统计学意义；p1组与p3组相比较，前者TPEF/tE、VPEF/VE、TPEF及VPEF值均低，RR则高于后者，差异有统计学意义（P0.05）；p1组与p3组相比较，前者TPEF/tE、VPEF/VE、TPEF及VPEF值均低，RR则高于后者，差异有统计学意义（P0.05）；p1组与p2组相比较，仅表现为VPEF值低于后者，差异有统计学意义（P0.05）；p2组除TPEF低于p3组，其余肺功能参数差异无统计学意义（P0.05）。 结论 1.潮气呼吸法适用于测定新生儿呼吸力学指标。 2.新生儿潮气呼吸肺功能主要受胎龄、体质量的影响，早产儿有明显的潮气呼吸肺功能受损，胎龄越小，以上变化越明显。
[Abstract]:Respiratory disease is one of the most common disease in preterm infants, but also an important cause of morbidity and mortality in recent years, the prevalence rate has been high. With the rapid development of perinatal medicine and medical level unceasing enhancement, our country in preterm infants (premature infant, PI) incidence rate has risen to 8.1%, the survival rate of premature infants increased significantly because of their lung development is not perfect, low weight, low immunity and other factors, prone to respiratory diseases, more and more clinical studies showed that the incidence rate of premature infant respiratory diseases increased year by year, because of the long time of hospitalization, cost is high, to the family, society brings great psychological burden and economic burden caused by height social concern in recent years.
Pulmonary function tests can be used not only to identify the nature of the respiratory system disease, severity of disease, drug treatment and assist in the evaluation of the effect of ventilator parameters selection also plays an important role, has become an important part of the prediction and monitoring of disease condition, widely used in respiratory medicine, pediatrics, Obstetrics and Gynecology, Department of thoracic surgery. Many areas of occupation disease assessment. The parameters of the normal value of pulmonary function in the diagnosis and treatment of diseases, plays an indispensable role in reference to judge the curative effect. Regular lung function determination need the active cooperation of the patients, which limits its application in children and in the newborn. And check the tidal breathing lung function only quiet breathing, so suitable for newborn neonatal lung function detection. From the beginning of the last century in 50s in the clinic, because the detection technology is backward, neonatal tidal volume small, the accuracy of the test result because of poor With the rapid development of computers, the research of neonatal lung function has been carried out extensively. However, there are few studies on the lung function of premature infants in China, and there is a lack of randomized controlled study on the lung function of premature infants.
objective
Pulmonary function was tested by dynamic different gestational age in preterm infants without respiratory disease during hospitalization, to understand the characteristics of early postnatal tidal breathing lung function and respiratory parameters; follow-up of discharged premature infants, explore the corrected gestational age changes of tidal breathing lung function and important respiratory parameters at 40 weeks, compared to the the difference between group and pulmonary function control, and analyze the influencing factors, to improve the understanding of pulmonary function of premature infants, and provide clinical reference value.
Method
1 group of research objects
Study from February 2013 to October 2013 of 75 premature infants in Pediatric Hospital Affiliated Hospital of Zhengzhou University third (premature infant, PI), are appropriate for gestational age, Caesarean birth, birth Apgar score of 7; full-term infants admitted during the same period (term infant, TI) 55 cases of the control group. Caesarean birth, gestational age (gestational, age, GA) 39~40 weeks.
Exclusion criteria: 1., there were respiratory symptoms such as respiratory distress and other respiratory symptoms. 2. of the mothers had smoking history, 3. had first-degree relatives of asthma, 4. had congenital diseases affecting lung function, and 5. had used.2 for lung function before the trial.
This study selected tidal breathing method in neonatal sleep drugs (drug with 5% chloral hydrate 0.5 ~ 0.8ml / kg enema or oral) or natural sleep, quiet breathing condition, the mask to fasten the mouth and nose, through the flow velocity sensor signal integral capacity, computer can display the measured value determination. The routine records in gestational age, gender, body length and body weight measurement, the experimental group and the control group to determine the tidal breathing lung function in 3-5 days after birth. Each test 3 times, the average value was calculated automatically by the computer. Can be used in the determination of main parameters are: tidal volume (Tidal volume VT) body weight, tidal volume per kilogram (Tidalvolume/kg, VT/kg), inspiratory time (Inspiratory time, tI (Expiratory), expiratory time time, tE), breathing (Ratio tI to tE, more than tI/tE), respiratory rate (Respiratory rate, RR), time to peak (Time, toPTEF, TPEF), peak Time ratio (Ratio of TPEF and total tE, TPEF/tE), peak volume (Expiratory volume at PTEF, VPEF), and peak volume ratio.
Follow up the experimental group, the corrected gestational age of 40 weeks were measured again on the tidal breathing lung function, using statistical methods to analyze, explore the changes and influence factors of different gestational age of premature infants and the corrected gestational age of 40 weeks the main respiratory parameters, and compare the difference between the full-term infants' lung function.
Result
Difference of major pulmonary function parameters between each group after 1. birth and 3-5 days
Smaller gestational age in P1 group and P2 group, low birth weight, pulmonary hypoplasia, TPEF, TPEF/tE, VPEF, VPEF/VE values were significantly lower than those of TI group, the RR value is higher than that of TI group (P0.05); P3 group and TI group in tI, TPEF, TPEF/tE, no statistically significant difference in the rest of the lung function parameters (P0.05); group P1 compared with group P3, tI, TPEF, TPEF/tE, VPEF, the difference was statistically significant VPEF/VE and RR values (P0.05); group P1 compared with group P2, TPEF, TPEF/tE, there was a significant difference in VPEF and VPEF/VE (P0.05); P2 group in addition to RR, tI and TPEF, no significant remaining lung function parameters compared with the P3 group difference (P0.05).
Difference of pulmonary function parameters between 2. preterm infants at 40 weeks of correction of fetal age
涓嶵I缁勭浉姣旇緝,p1缁勬牎姝ｈ儙榫

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