Department of Perinatology, Jeanne de Flandre Hospital, University Hospital of Lille, and EA4489 Perinatal Environment and Growth, School of Medicine, Université Lille 2, Lille, France.
J Pediatr. 2013 Jun;162(6):1133-7, 1137.e1. doi: 10.1016/j.jpeds.2012.11.036. Epub 2013 Jan 11.
To compare breathing patterns and lung function in the supine, lateral, and prone positions in oxygen-dependent preterm infants.
Respiratory function in preterm infants receiving nasal continous positive airway pressure therapy for mild respiratory failure was evaluated by respiratory inductive plethysmography. Infants were randomized to supine, left lateral, and prone positions for 3 hours. A nest provided a semiflexed posture for the infants placed in the left lateral position, similar to the in utero position. Tidal volume (Vt), phase angle between abdominal and thoracic movements, rib cage contribution to Vt, and dynamic elevation of end-expiratory lung volume were measured.
Fraction of inspired O2 was similar in the 3 positions for 19 infants (mean gestational age, 27±2 weeks; mean birth weight, 950±150 g; mean postnatal age, 17±5 days). However, arterial O2 saturation and Vt were higher in the left lateral and prone positions than in the supine position (P<.05). The phase angle between abdominal and thoracic movements was lower and rib cage contribution to Vt was higher in the left lateral and prone positions than in the supine position (P<.05). Dynamic elevation of end-expiratory lung volume was greater in the supine position than in the left lateral and prone positions (P<.05).
In oxygen-dependent preterm infants, both the left lateral and prone positions improve lung function by optimizing breathing strategy. In the neonatal intensive care unit, the left lateral position can be used as an alternative to the prone position for mild respiratory failure.
比较依赖吸氧的早产儿仰卧位、侧卧位和俯卧位时的呼吸模式和肺功能。
采用呼吸感应体积描记法评估接受经鼻持续气道正压通气治疗的轻度呼吸衰竭早产儿的肺功能。将婴儿随机分为仰卧位、左侧卧位和俯卧位，各 3 小时。左侧卧位时，婴儿被安置在一个巢中，保持半屈曲姿势，类似于宫内位置。测量潮气量（Vt）、腹部和胸部运动之间的相位角、胸廓对 Vt 的贡献以及呼气末肺容积的动态升高。
19 名婴儿（平均胎龄 27±2 周；平均出生体重 950±150g；平均出生后年龄 17±5 天）在 3 个位置的吸入氧分数相似。然而，左侧卧位和俯卧位时的动脉血氧饱和度和 Vt 高于仰卧位（P<.05）。左侧卧位和俯卧位时腹部和胸部运动之间的相位角较低，胸廓对 Vt 的贡献较高（P<.05）。仰卧位时呼气末肺容积的动态升高大于左侧卧位和俯卧位（P<.05）。
在依赖吸氧的早产儿中，左侧卧位和俯卧位均可通过优化呼吸策略来改善肺功能。在新生儿重症监护病房中，对于轻度呼吸衰竭，左侧卧位可以替代俯卧位。
