Robin Beverley, Kim Young-Jee, Huth Jaimee, Klocksieben Jim, Torres Margaret, Tepper Robert S, Castile Robert G, Solway Julian, Hershenson Marc B, Goldstein-Filbrun Amy
Department of Pediatrics, University of Chicago Children's Hospital, University of Chicago, Chicago, Illinois, USA.
Pediatr Pulmonol. 2004 Mar;37(3):236-42. doi: 10.1002/ppul.10424.
The purpose of this study was to examine lung function and bronchodilator responsiveness in infants with a history of prematurity and bronchopulmonary dysplasia (BPD), using the raised volume rapid thoracoabdominal compression technique as well as with whole-body plethysmography. Spirometric measurements were obtained in 28 infants with a history of BPD, defined as preterm birth with O2 requirement at 36 weeks postmenstrual age (gestational age at birth, 26.4 +/- 2.1 weeks, mean +/- SD; birthweight, 898 +/- 353 g; age at study, 68.0 +/- 35.6 weeks). Fractional lung volumes were measured in 27 subjects. Values were expressed as percentage of predicted normal values. Compared to normal infants, those with a history of BPD exhibited decreases in forced expiratory flows including forced expiratory volume in 0.5 sec (76.3 +/- 19.6%), forced expiratory flow at 75% of expired forced vital capacity (FEF75; 59.5 +/- 30.7%), and FEF(25-75) (74.0 +/- 26.8%; P<0.01 for all). Functional residual capacity (107.9 +/- 25.3%), residual volume (RV, 124.5 +/- 42.7%), and RV/total lung capacity (RV/TLC, 128.2 +/- 35.3%) were increased in infants with a history of BPD (P<0.05 for each). There was no difference in TLC between groups. Seventeen infants were studied both pre- and postalbuterol, and 6 (35%) demonstrated significant bronchodilator responsiveness. Infants with recurrent wheezing showed greater expiratory flow limitation, hyperinflation, and airways responsiveness, whereas those without wheezing showed only modest airway dysfunction. We conclude that infants with a history of BPD have pulmonary function abnormalities characterized by mild to moderate airflow obstruction and air trapping.
本研究的目的是采用增加容积快速胸腹按压技术以及全身体积描记法，检测有早产和支气管肺发育不良（BPD）病史婴儿的肺功能和支气管扩张剂反应性。对28例有BPD病史的婴儿进行了肺量计测量，BPD定义为月经后36周需吸氧的早产（出生孕周，26.4±2.1周，均值±标准差；出生体重，898±353 g；研究时年龄，68.0±35.6周）。对27例受试者测量了肺容积分数。数值以预测正常值的百分比表示。与正常婴儿相比，有BPD病史的婴儿用力呼气流量降低，包括0.5秒用力呼气量（76.3±19.6%）、呼出用力肺活量75%时的用力呼气流量（FEF75；59.5±30.7%）和FEF(25 - 75)（74.0±26.8%；均P<0.01）。有BPD病史的婴儿功能残气量（107.9±25.3%）、残气量（RV，124.5±42.7%）和RV/肺总量（RV/TLC，128.2±35.3%）增加（各P<0.05）。两组间肺总量无差异。对17例婴儿在使用沙丁胺醇前后进行了研究，6例（35%）表现出显著的支气管扩张剂反应性。有反复喘息的婴儿表现出更大的呼气流量受限、肺过度充气和气道反应性，而无喘息的婴儿仅表现出轻度气道功能障碍。我们得出结论，有BPD病史的婴儿存在以轻度至中度气流阻塞和气体潴留为特征的肺功能异常。
