Nakayama D K, Mutich R, Motoyama E K
Department of Pediatric Surgery, Children's Hospital of Pittsburgh, PA.
Crit Care Med. 1991 Jul;19(7):926-33. doi: 10.1097/00003246-199107000-00017.
To describe the pathophysiology of surgical conditions that are associated with respiratory insufficiency in the newborn infant.
Survey.
Newborn ICU in a children's hospital.
Twenty-four newborn infants (1 to 28 days old) who required endotracheal intubation and mechanical ventilation for operative procedures or postoperative ventilatory support.
Flow-volume curves obtained by manual inflation of the lungs, followed by forced deflation by negative pressure, and by passive expiration, under sedation and pharmacologic paralysis.
Deflation flow-volume curves and passive expiratory curves were measured. Pulmonary function testing before and after bronchodilator administration (n = 11) began midway during the study period. Term and preterm groups served as controls.
Forced vital capacity (FVC) was decreased in all groups with surgical disease as follows: abdominal wall defects and necrotizing enterocolitis groups to 48.3% and 62.1% that of preterm, respectively; pulmonary hypoplasia group to 55.5% that of term (p less than .05). Maximal expiratory flow at 25% of FVC decreased in all groups: abdominal wall defects and necrotizing enterocolitis group, to 36.8% and 37.9% that of preterm, respectively (p less than .05); pulmonary hypoplasia group, 20.0% that of term (p less than .05). The ratio of maximal expiratory flow at 25% of FVC divided by FVC was significantly decreased in necrotizing enterocolitis and pulmonary hypoplasia groups compared with that of preterm and term groups, respectively, but not in the abdominal wall defects group. Maximal expiratory flow at 25% of FVC, but not FVC, increased significantly (36%, p less than .05) after bronchodilator nebulization, indicating the presence of airway reactivity. Respiratory system compliance was decreased significantly (p less than .05) in all surgical disease groups compared with the term group.
Bronchial reactivity contributes to decreased maximal expiratory flow at 25% of FVC, a feature also seen in premature infants with respiratory distress syndrome who later develop bronchopulmonary dysplasia. Babies who require chronic ventilatory support after operation and who have developed reactive airways may benefit from the administration of bronchodilators during postoperative ventilatory management.
描述与新生儿呼吸功能不全相关的外科疾病的病理生理学。
调查。
一家儿童医院的新生儿重症监护病房。
24名新生儿（1至28日龄），因手术操作或术后通气支持需要气管插管和机械通气。
在镇静和药物性麻痹状态下，通过手动充气肺，随后用负压强制放气以及被动呼气来获取流量-容积曲线。
测量放气流量-容积曲线和被动呼气曲线。在研究期间中途开始对11名患者进行支气管扩张剂给药前后的肺功能测试。足月儿和早产儿组作为对照。
所有患有外科疾病的组的用力肺活量（FVC）均降低，情况如下：腹壁缺损组和坏死性小肠结肠炎组分别降至早产儿的48.3%和62.1%；肺发育不全组降至足月儿的55.5%（p<0.05）。所有组在FVC的25%时的最大呼气流量均降低：腹壁缺损组和坏死性小肠结肠炎组分别降至早产儿的36.8%和37.9%（p<0.05）；肺发育不全组降至足月儿的20.0%（p<0.05）。与早产儿组和足月儿组相比，坏死性小肠结肠炎组和肺发育不全组在FVC的25%时的最大呼气流量除以FVC的比值分别显著降低，但腹壁缺损组未出现这种情况。雾化吸入支气管扩张剂后，FVC的25%时的最大呼气流量显著增加（36%，p<0.05），但FVC未增加，表明存在气道反应性。与足月儿组相比，所有外科疾病组的呼吸系统顺应性均显著降低（p<0.05）。
支气管反应性导致FVC的25%时的最大呼气流量降低，这一特征在后来发展为支气管肺发育不良的呼吸窘迫综合征早产儿中也可见到。术后需要长期通气支持且已出现气道反应性的婴儿在术后通气管理期间使用支气管扩张剂可能有益。
