Dassios Theodore, Curley Anna, Krokidis Miltiadis, Morley Colin, Ross-Russell Robert
Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK; Neonatal Intensive Care Unit, Cambridge University Hospitals, Cambridge, UK.
Neonatal Intensive Care Unit, Cambridge University Hospitals, Cambridge, UK.
Respir Physiol Neurobiol. 2016 Jan;220:40-5. doi: 10.1016/j.resp.2015.09.009. Epub 2015 Sep 26.
We hypothesized that radiographically-assessed hyperinflation in bronchopulmonary dysplasia (BPD) is related to the degree of oxygenation impairment. Our objective was to explore the relation of chest radiographic thoracic area (CRTA) with right-to-left shunt, right shift of the oxyhemoglobin dissociation curve and ventilation/perfusion ratio (VA/Q) in infants with BPD. Twenty-two infants born at median (IQR) gestation of 26 (24-28) weeks with BPD were prospectively studied at 39 (30-69) days. Inspired oxygen (FiO2) was varied to obtain transcutaneous oxygen saturation (SpO2) values between 85 and 96%. Shunt, shift and VA/Q were derived by plotting and analysing pairs of SpO2 and FiO2. CRTA was measured by free hand-tracing the perimeter of the thoracic area in anterio-posterior chest radiographs. Median (IQR) shunt was 8 (1-14)%, shift was 13 (11-19)kPa and VA/Q 0.42 (0.30-0.48). Median (IQR) CRTA/kg was 2495 (1962-2838)mm(2) and was significantly related to shift (r=0.674, p<0.001), VA/Q (r=-0.633, p<0.001), weight at study (r=-0.457, p=0.003) and day of life (r=-0.406, p=0.009), but not to shunt. CRTA in BPD is significantly related to oxygenation impairment as quantified by shift and VA/Q. CRTA can be used as a simple radiographic test to quantify BPD severity.
我们假设，支气管肺发育不良（BPD）中经影像学评估的肺过度充气与氧合受损程度相关。我们的目的是探讨BPD婴儿的胸部X线胸廓面积（CRTA）与右向左分流、氧合血红蛋白解离曲线右移及通气/灌注比（VA/Q）之间的关系。对22例孕龄中位数（IQR）为26（24 - 28）周的BPD婴儿在出生39（30 - 69）天时进行前瞻性研究。改变吸入氧浓度（FiO2）以获得经皮血氧饱和度（SpO2）在85%至96%之间的值。通过绘制和分析成对的SpO2和FiO2得出分流、曲线右移和VA/Q。通过徒手描绘前后位胸部X线片上胸廓区域的周长来测量CRTA。中位数（IQR）分流为8（1 - 14）%，曲线右移为13（11 - 19）kPa，VA/Q为0.42（0.30 - 0.48）。中位数（IQR）CRTA/体重为2495（1962 - 2838）mm²，且与曲线右移（r = 0.674，p < 0.001）、VA/Q（r = -0.633，p < 0.001）、研究时体重（r = -0.457，p = 0.003）及日龄（r = -0.406，p = 0.009）显著相关，但与分流无关。BPD中的CRTA与通过曲线右移和VA/Q量化的氧合受损显著相关。CRTA可作为一种简单的影像学检查来量化BPD的严重程度。
