早期使用肺表面活性物质对支气管肺发育不良婴幼儿肺功能的影响研究
发布时间：2018-07-24 22:10
【摘要】：目的： 探讨早期使用肺表面活性物质（Pulmonary surfactant，PS)对支气管肺发育不良（Bronchopulmonary Dysplasia,BPD）患儿婴幼儿时期肺功能的影响，为改善BPD患儿的肺功能提供理论依据。 方法： 1.回顾性分析广东省妇幼保健院2011年4月至2012年4月产科出生，并入住新生儿重症监护室（neonatal intensive care unit）NICU的早产儿的病例资料。 2.将诊断为BPD的病例，按照是否使用PS将其分为PS组及非PS组，采用电话随访及门诊随访的方法，记录两组患儿1岁、2岁时的肺功能、身高、体重、因呼吸系统疾病入院次数、哮喘家族性疾病史。 3.采用潮气呼吸的方法，在水合氯醛镇静状态下，应用美国Carefusiong肺功能仪，检测两组患儿1岁、2岁时的潮气呼吸肺功能，将数据记录在BPD随访调查表格中。 4.将所得数据在Excel表中建立数据库,使用SPSS19.0软件对所得数据进行统计学分析。 结果： 1.早产儿一般情况： 共995例早产儿的病例资料，排除28天内放弃或死亡48例病例，余947例纳入研究对象，其中男564例（59.6%），女383例（40.4%），平均胎龄32.25±1.35周，平均体重2060.24±560g,发生BPD的病例共54例，BPD病例在研究期限早产儿的发病率为5.70%。 2.BPD患儿一般情况： 在此研究年限中，有54例BPD病例，其中抢救无效死亡4例，家属放弃治疗6例，4例合并其他严重疾病，剩余40例，纳入随访研究，依据纠正胎龄36周时进行评估，病情严重程度为：轻度15例（37.5%），中度16例（40.0%），重度9例（22.5%）。平均胎龄28.56±1.69周，平均出生体重1152.82±216.41g；PS组26例，非PS组14例。 3.两组患儿出生情况及住院期间情况： PS组平均胎龄28.33±1.17周，，平均体重1070±110g，轻度BPD9例，中度BPD11例，重度BPD6例；住院期间患肺炎21例，患肺出血1例，有哮喘病家族史1例，RDS21例；平均机械通气时间13.32±5.49d,平均吸氧时间59.04±4.32d；非PS组平均胎龄28.83±0.90周，平均体重1140±900g,轻度BPD6例，中度BPD5例，重度BPD3例，患肺炎10例，患肺出血1例，有哮喘家族史1例，RDS11例；平均机械通气时间15.60±3.75d,平均吸氧时间62.38±4.01d； 两组患儿病情严重程度无明显差异，χ2等于0.307，p＞0.05； 两组患儿胎龄、出生体重、住院期间合并症无明显差异，p＞0.05；两组患儿的机械通气时间、吸氧时间存在统计学差异，p＜0.05； 4.随访结果： 1岁时:PS组失访2例，非PS组失访1例； 2岁时:PS组失访1例，非PS组失访1例； 1岁时PS组的肺功能参数值为RR29.87±1.03次/分、TPTEF/TE26.73±0.94%、VPEF/VE28.23±0.75%、Ti0.87±0.04s、Te1.28±0.04s、VT7.96±0.53ml/kg、身高69.88±2.12cm、体重7.88±0.54kg；非PS组RR30.77±1.01次/分、TPTEF/TE25.75±0.77%、VPEF/VE27.27±0.78%、Ti0.87±0.04s、Te1.31±0.03s、VT7.53±0.51ml/kg、身高70.00±2.08cm、体重7.76±0.87kg，经统计分析结果显示：非PS组较PS组RR和Te增加，TPTEF/TE、VPEF/VE2和VT下降，P＜0.05，差异有统计学意义，Ti无明显差异，P＞0.05；两组患儿身高、体重、哮喘家族疾病史的比较，差异无明显统计学意义，P＞0.05；非PS组因呼吸系统疾病入院次数增加，两组差异有统计学意义，P＜0.05。 2岁时PS组的肺功能参数值为RR24.91±0.73次/分、TPTEF/TE27.94±0.58%、VPEF/VE29.79±0.64%、Ti1.05±0.04s、Te1.46±0.05s、VT8.76±0.53ml/kg、身高87.71±1.75cm、体重12.53±0.96kg；非PS组RR25.75±0.75次/分、TPTEF/TE27.41±0.61%、VPEF/VE28.89±0.72%、Ti1.06±0.04s、Te1.49±0.03s、VT8.30±0.48ml/kg、身高86.33±3.56cm、体重12.00±0.63kg,经t检验PS组较PS组RR增加，Te延长，TPTEF/TE、VPEF/VE下降，P＜0.05，差异有统计学意义，VT下降，P＞0.05，差异无统计学意义。两组患儿身高、体重、哮喘家族疾病史的比较，差异无明显统计学意义，P＞0.05；非PS组因呼吸系统疾病入院次数增加，差异有统计学意义，P＜0.05； 结论： 1.早期使用PS替代治疗可以改善BPD患儿1岁、2岁时的肺功能及减少因呼吸系统疾病入院次数。 2.早期使用PS替代治疗对BPD患儿1岁、2岁时的身高、体重无明显改善作用。
[Abstract]:Objective:
To explore the effect of early Pulmonary surfactant (PS) on the pulmonary function of children with bronchopulmonary dysplasia (Bronchopulmonary Dysplasia, BPD) in infants and infants, and to provide a theoretical basis for improving the pulmonary function of children with BPD.
Method:
1. a retrospective analysis of the cases of the premature infants born in the Guangdong Provincial Maternity and Child Care Center from April 2011 to April 2012 and in the neonatal intensive care unit (neonatal intensive care unit) NICU.
2. the cases diagnosed as BPD were divided into PS group and non PS group according to whether PS was used. By telephone follow-up and outpatient follow-up, the lung function, height, weight, hospitalization times of respiratory diseases and family history of asthma were recorded at the age of 1, 2 years old.
3. using the method of tidal breathing, under the sedative state of chloral hydrate, the Carefusiong lung function instrument was used to detect the tidal breathing and lung function of two groups of children at the age of 1 and 2 years, and the data were recorded in the BPD follow-up survey form.
4. Set up the database in Excel table and use SPSS19.0 software to analyze the data.
Result:
1. the general situation of preterm infants:
A total of 995 cases of preterm infants were used to exclude 48 cases of abandonment or death within 28 days. The remaining 947 were included in the study, including 564 males (59.6%), 383 women (40.4%), average fetal age of 32.25 + 1.35 weeks, average weight of 2060.24 560g, cases of BPD, and BPD disease in premature infants with the incidence of 5.70%.
General situation of children with 2.BPD:
In this study, there were 54 cases of BPD cases, of which 4 cases were invalid, 6 cases were abandoned, 4 cases were combined with other serious diseases, and the remaining 40 cases were followed up for 36 weeks. The severity of the disease was 15 cases (37.5%), moderate 16 (40%), and 9 (22.5%). The average birth weight was 1152.82 [216.41g], 26 cases in PS group and 14 cases in non-PS group.
3. the birth status and duration of hospitalization in two groups of children:
The average gestational age of group PS was 28.33 + 1.17 weeks, the average weight was 1070 + 110g, mild BPD9, moderate BPD11, severe BPD6, 21 cases of pneumonia and 1 cases of pulmonary hemorrhage during hospitalization, 1 cases of asthma family history, RDS21 cases, average mechanical ventilation time 13.32 + 5.49d, average oxygen absorption time 59.04 + 4.32d, average age of 28.83 + 0.90 weeks in non PS group, average weight 1 140 900g, mild BPD6, moderate BPD5, severe BPD3, pneumonia in 10 cases, pulmonary hemorrhage in 1 cases, with family history of asthma in 1 cases, RDS11 cases, the average mechanical ventilation time was 15.60 + 3.75d, and the average oxygen inhalation time was 62.38 + 4.01d;
There was no significant difference in severity between the two groups, _2was equal to 0.307, P > 0.05.
There was no significant difference between the two groups of gestational age, birth weight, and hospitalization, P > 0.05. The mechanical ventilation time and the oxygen absorption time in the two groups were statistically different, P < 0.05;
4. follow up results:
At 1 years of age, 2 cases were lost in group PS, and 1 cases in non PS group were lost.
At 2 years of age, 1 cases were lost in group PS, and 1 cases in non PS group were lost.
At the age of 1, the pulmonary function parameters of group PS were RR29.87 + 1.03 / min, TPTEF/TE26.73 + 0.94%, VPEF/VE28.23 + 0.75%, Ti0.87 + 0.04s, Te1.28 + 0.04s, VT7.96 + 0.53ml/kg, height 69.88 + 2.12cm, weight 7.88 + 0.54kg. G, height 70 + 2.08cm, weight 7.76 + 0.87kg, the results of statistical analysis showed that the RR and Te in the non PS group were increased, TPTEF/TE, VPEF/VE2 and VT decreased, P < 0.05, the difference was statistically significant, there was no significant difference between the two groups, and there was no significant difference between the two groups of children's height, weight, and the family history of asthma. The number of hospitalizations for respiratory diseases in group A was higher than that in group B (P < 0.05).
At the age of 2, the pulmonary function parameters of group PS were RR24.91 + 0.73 / min, TPTEF/TE27.94 + 0.58%, VPEF/VE29.79 + 0.64%, Ti1.05 + 0.04s, Te1.46 + 0.05s, VT8.76 + 0.53ml/kg, height 87.71 + 1.75cm, weight 12.53 + 0.96kg. Kg, height 86.33 + 3.56cm, weight 12 + 0.63kg, after t test, PS group was more RR than PS group, Te prolonged, TPTEF/TE, VPEF/VE decreased, P < 0.05, the difference was statistically significant, VT declined, > 0.05, the difference was not statistically significant. The difference between the two groups of children's height, weight, and the family history of asthma was no significant difference, 0.05 The number of hospitalized patients with aspiration system diseases increased, and the difference was statistically significant (P < 0.05).
Conclusion:
1. early use of PS replacement therapy can improve lung function in children with BPD at 1 years of age and 2 years of age, and reduce the number of hospitalization due to respiratory diseases.
2. the early use of PS replacement therapy did not significantly improve the height and weight of BPD children at 1 years of age and 2 years of age.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R722.6
本文编号：2142814
[Abstract]:Objective:
To explore the effect of early Pulmonary surfactant (PS) on the pulmonary function of children with bronchopulmonary dysplasia (Bronchopulmonary Dysplasia, BPD) in infants and infants, and to provide a theoretical basis for improving the pulmonary function of children with BPD.
Method:
1. a retrospective analysis of the cases of the premature infants born in the Guangdong Provincial Maternity and Child Care Center from April 2011 to April 2012 and in the neonatal intensive care unit (neonatal intensive care unit) NICU.
2. the cases diagnosed as BPD were divided into PS group and non PS group according to whether PS was used. By telephone follow-up and outpatient follow-up, the lung function, height, weight, hospitalization times of respiratory diseases and family history of asthma were recorded at the age of 1, 2 years old.
3. using the method of tidal breathing, under the sedative state of chloral hydrate, the Carefusiong lung function instrument was used to detect the tidal breathing and lung function of two groups of children at the age of 1 and 2 years, and the data were recorded in the BPD follow-up survey form.
4. Set up the database in Excel table and use SPSS19.0 software to analyze the data.
Result:
1. the general situation of preterm infants:
A total of 995 cases of preterm infants were used to exclude 48 cases of abandonment or death within 28 days. The remaining 947 were included in the study, including 564 males (59.6%), 383 women (40.4%), average fetal age of 32.25 + 1.35 weeks, average weight of 2060.24 560g, cases of BPD, and BPD disease in premature infants with the incidence of 5.70%.
General situation of children with 2.BPD:
In this study, there were 54 cases of BPD cases, of which 4 cases were invalid, 6 cases were abandoned, 4 cases were combined with other serious diseases, and the remaining 40 cases were followed up for 36 weeks. The severity of the disease was 15 cases (37.5%), moderate 16 (40%), and 9 (22.5%). The average birth weight was 1152.82 [216.41g], 26 cases in PS group and 14 cases in non-PS group.
3. the birth status and duration of hospitalization in two groups of children:
The average gestational age of group PS was 28.33 + 1.17 weeks, the average weight was 1070 + 110g, mild BPD9, moderate BPD11, severe BPD6, 21 cases of pneumonia and 1 cases of pulmonary hemorrhage during hospitalization, 1 cases of asthma family history, RDS21 cases, average mechanical ventilation time 13.32 + 5.49d, average oxygen absorption time 59.04 + 4.32d, average age of 28.83 + 0.90 weeks in non PS group, average weight 1 140 900g, mild BPD6, moderate BPD5, severe BPD3, pneumonia in 10 cases, pulmonary hemorrhage in 1 cases, with family history of asthma in 1 cases, RDS11 cases, the average mechanical ventilation time was 15.60 + 3.75d, and the average oxygen inhalation time was 62.38 + 4.01d;
There was no significant difference in severity between the two groups, _2was equal to 0.307, P > 0.05.
There was no significant difference between the two groups of gestational age, birth weight, and hospitalization, P > 0.05. The mechanical ventilation time and the oxygen absorption time in the two groups were statistically different, P < 0.05;
4. follow up results:
At 1 years of age, 2 cases were lost in group PS, and 1 cases in non PS group were lost.
At 2 years of age, 1 cases were lost in group PS, and 1 cases in non PS group were lost.
At the age of 1, the pulmonary function parameters of group PS were RR29.87 + 1.03 / min, TPTEF/TE26.73 + 0.94%, VPEF/VE28.23 + 0.75%, Ti0.87 + 0.04s, Te1.28 + 0.04s, VT7.96 + 0.53ml/kg, height 69.88 + 2.12cm, weight 7.88 + 0.54kg. G, height 70 + 2.08cm, weight 7.76 + 0.87kg, the results of statistical analysis showed that the RR and Te in the non PS group were increased, TPTEF/TE, VPEF/VE2 and VT decreased, P < 0.05, the difference was statistically significant, there was no significant difference between the two groups, and there was no significant difference between the two groups of children's height, weight, and the family history of asthma. The number of hospitalizations for respiratory diseases in group A was higher than that in group B (P < 0.05).
At the age of 2, the pulmonary function parameters of group PS were RR24.91 + 0.73 / min, TPTEF/TE27.94 + 0.58%, VPEF/VE29.79 + 0.64%, Ti1.05 + 0.04s, Te1.46 + 0.05s, VT8.76 + 0.53ml/kg, height 87.71 + 1.75cm, weight 12.53 + 0.96kg. Kg, height 86.33 + 3.56cm, weight 12 + 0.63kg, after t test, PS group was more RR than PS group, Te prolonged, TPTEF/TE, VPEF/VE decreased, P < 0.05, the difference was statistically significant, VT declined, > 0.05, the difference was not statistically significant. The difference between the two groups of children's height, weight, and the family history of asthma was no significant difference, 0.05 The number of hospitalized patients with aspiration system diseases increased, and the difference was statistically significant (P < 0.05).
Conclusion:
1. early use of PS replacement therapy can improve lung function in children with BPD at 1 years of age and 2 years of age, and reduce the number of hospitalization due to respiratory diseases.
2. the early use of PS replacement therapy did not significantly improve the height and weight of BPD children at 1 years of age and 2 years of age.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R722.6
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