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极早产儿的通气和8岁时的呼吸功能
Ventilation in Extremely Preterm Infants and Respiratory Function at 8 Years


Lex W. Doyle ... 呼吸系统疾病 妇产科和儿科 • 2017.07.27
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摘要


背景

尽管极早产儿(孕龄不足28周)辅助通气的侵入性已减小,但目前还不清楚这种治疗的进步是否与近期或远期肺功能的改善有关联。我们在出生时极早产的儿童中比较了以下各项随时间推移发生的变化:新生儿期辅助通气和氧疗的使用,以及8岁时的肺功能。

 

方法

我们对三个时期在澳大利亚维多利亚州出生的所有极早产幸存者开展了纵向随访:1991年和1992年出生的225名婴儿、1997年出生的151名婴儿和2005年出生的170名婴儿。前瞻性收集围生期数据,包括辅助通气的持续时间和类型,氧疗持续时间以及36周龄时的氧需求情况。在8岁时测定呼气流量,并将数值转换为相应年龄、身高、族群和性别的z评分。

 

结果

随时间推移,辅助通气的持续时间明显增加,经鼻持续气道正压通气的持续时间大幅增加。尽管随时间推移微侵入式通气的使用增加,但2005年组与较早期的两组相比,36周龄时的氧疗持续时间和氧依赖率上升,8岁时的呼气流量减少。例如,2005年组与1991~1992年组相比,第一秒用力呼气量与用力肺活量之比的z评分平均差值为-0.75(95%置信区间[CI],-1.07~-0.44;P<0.001),而2005年组与1997年组的平均差值为-0.53(95% CI,-0.86~-0.19;P=0.002)。

 

结论

尽管出生后微侵入式通气的使用大幅增加,但36周龄时的氧依赖并未随时间推移而显著减少,儿童肺功能没有显著改善(由澳大利亚国家健康与医学研究委员会[National Health and Medical Research Council of Australia]和维多利亚州政府的运营基础设施支持计划[Victorian Government’s Operational Infrastructure Support Program]资助)。





作者信息

Lex W. Doyle, M.D., Elizabeth Carse, M.D., Anne-Marie Adams, Ph.D., Sarath Ranganathan, Ph.D., Gillian Opie, M.B., B.S., and Jeanie L.Y. Cheong, M.D. for the Victorian Infant Collaborative Study Group*
From Neonatal Services, Royal Women’s Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children’s Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) — all in Melbourne, VIC, Australia. Address reprint requests to Dr. Doyle at Royal Women’s Hospital, Parkville, VIC 3052, Australia, or at lwd@unimelb.edu.au. *A complete list of members of the Victorian Infant Collaborative Study Group is provided in the Supplementary Appendix, available at NEJM.org.

 

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