超声流量仪对不同胎龄早产儿及支气管肺发育不良婴儿肺功能监测

发布时间：2018-04-22 21:33

  本文选题：早产儿 + 支气管肺发育不良　； 参考：《重庆医科大学》2012年硕士论文

【摘要】：目的:探讨无肺部并发症的不同孕周早产儿肺功能的动态变化,以及比较在纠正胎龄37-41周期间时支气管肺发育不良(Bronchopulmonary dysplasia, BPD)患儿和非BPD早产儿间肺功能的差别,评估早产和支气管肺发育不良对肺功能的影响。 方法：对34名健康足月儿，30名晚期新生儿和25名出生胎龄小于34周非支气管肺发育不良早产儿在生后平均7、14、28日龄和纠正胎龄在37-41周期间，在安静自然睡眠状态下，取仰卧位，运用超声流量仪，氦气（He）作为示踪惰性气体，采用反复呼吸气体洗出法进行潮气呼吸和肺功能残气量及代表通气效率的肺清除指数（Lung ClearIndex，LCI）测量,同时，对发生BPD的患儿，在纠正胎龄37-41周期间按上述方法进行相关肺功能指标测试。 结果：三组患儿肺功能均随着日龄的增加而改善，流速容量环呈不典型椭圆型，出生胎龄越小越明显；在纠正胎龄37-41周期间，晚期新生儿各项肺功能参数接近足月新生儿水平，而小于34周早产儿未能实现肺功能的追赶式生长。BPD组、出生胎龄小于34周的非BPD早产儿组与足月儿组相比较，功能残气量（FRC/kg）降低，差别具有统计学意义，（分别为16.45±3.03，18.61±1.84，20.67±2.24，F=14.59，P0.001）,代表肺通气均匀性的肺清除指数(LCI)增高，（分别为7.92±1.05，7.18±0.70，，6.56±0.75，F=17.99, P0.001）;呼吸频率（RR）增快,(分别为50.91±3.57，47.00±6.04，39.21±5.39F=38.55, P0.001);呼气达峰时间比（TPTEF/TE）降低（分别为23.41±3.90，26.64±4.12，30.82±4.27，F=22.38,P0.001）；纠正胎龄37-41周期间， BPD组大部分患儿及部分非BPD早产儿流速-容量环形态变窄，高峰提前，同时下降支倾斜，甚至凹向容量轴，即流速容量环呈现特征性阻塞图形，以BPD改变较为明显。 结论：总之，不同胎龄早产儿，无论发生BPD与否，在新生儿期其肺功能逐步改善，在纠正胎龄37-41周时，BPD及非BPD极度早产儿均存在功能残气量和通气均匀性降低及小气道阻塞，以BPD患儿更为显著。
[Abstract]:Objective: to investigate the dynamic changes of pulmonary function in premature infants with different gestational weeks without pulmonary complications, and to compare the pulmonary function between children with bronchopulmonary dysplasia (BPDD) and non-preterm infants with bronchopulmonary dysplasia (BPDD) at 37 to 41 weeks of gestational age. To evaluate the effects of premature delivery and bronchopulmonary dysplasia on lung function. Methods: in 34 healthy term infants, 30 late neonates and 25 non-bronchopulmonary dysplasia preterm infants with gestational age less than 34 weeks were selected for supine position at the mean age of 7 ~ 14 ~ 28 days after birth and the corrected gestational age at 37-41 weeks under the condition of quiet natural sleep. Using ultrasonic flow meter and helium gas as tracer inert gas, repeated breath gas washing method was used to measure tidal breathing, lung function residual volume and lung clearance index (ClearLung Index LCI) representing ventilation efficiency. At the same time, the children with BPD were tested. During 37-41 weeks of corrected gestational age, lung function indexes were measured according to the above method. Results: the pulmonary function of the three groups improved with the increase of the age of day, the flow volume loop was atypical elliptical, the smaller the gestational age was, the more obvious the pulmonary function was, and the pulmonary function parameters of the late neonates were close to the level of full-term neonates during the period of 37-41 weeks of corrected gestational age. However, compared with the term group, the functional residual capacity of premature infants less than 34 weeks was lower than that of full-term infants in the catch-up growth. Bpd group and the non BPD premature infants with less than 34 weeks gestational age, compared with those in the term infants group. 宸�鍒�鍏锋湁缁熻�″�︽剰涔

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