保守治疗下动脉导管未闭的极早产儿的肺功能：一项观察性研究。
Lung function in very preterm infants with patent ductus arteriosus under conservative management: an observational study.
作者信息
Chen Hsiu-Lin, Yang Rei-Cheng, Lee Wei-Te, Lee Pei-Lun, Hsu Jong-Hau, Wu Jiunn-Ren, Dai Zen-Kong
机构信息
Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Pediatrics, Kaohsiung Medical University Hospital, No.100 , Tzyou 1st Road, San Ming District, Kaohsiung, 807, Taiwan.
出版信息
BMC Pediatr. 2015 Oct 24;15:167. doi: 10.1186/s12887-015-0480-y.
BACKGROUND
Persistent patent ductus arteriosus (PDA) during hospitalization is thought to be associated with adverse pulmonary outcomes in very preterm infants. This observational study aimed to compare the lung function in very preterm infants with and without PDA at discharge.
METHODS
Very preterm infants, admitted to our neonatal intensive unit, who required respiratory support soon after birth and had undergone a lung function test at discharge, were enrolled. Infants with a need for positive-pressure support (either an invasive ventilator, or nasal continuous positive airway pressure without oxygen) or supplemental oxygen at a postmenstrual age of 36 weeks were defined as having bronchopulmonary dysplasia (BPD). Echocardiography was performed weekly for each of the very preterm infants with PDA to confirm closure of the PDA. The data were collected retrospectively.
RESULTS
Fifty-two very preterm infants received lung function tests before discharge during the study period, 28 of whom had PDA and received conservative management, and 20 who did not. The other 4 infants who were given active treatment for PDA were excluded. Gestational age was significantly smaller in the PDA group than in the no-PDA group (27.1 ± 2.0 vs. 28.6 ± 1.6 weeks, p = 0.009). Birth weight did not differ significantly in those with and those without PDA (0.98 ± 0.26 vs. 1.12 ± 0.26 kg, p = 0.074). Significantly more infants with PDA had BPD (p = 0.002) and required respiratory support for a longer period (p = 0.001) than those without PDA. However, functional residual capacity (ml/kg) at discharge was comparable between the two groups after adjusting for gestational age and postmenstrual age at testing (21.6 ± 8.4 vs. 21.5 ± 6.7 ml/kg, p = 0.894). Other lung function test parameters were also comparable.
CONCLUSION
Under a definition of BPD (including infants needing CPAP but without oxygen) other than the conventional definition, the very preterm infants in our study who received conservative management for PDA had a higher percentage of BPD than the infants without PDA. The parameters of the lung function test and lung clearance index were comparable between these two groups at discharge.
背景
住院期间持续性动脉导管未闭（PDA）被认为与极早产儿不良肺部结局相关。本观察性研究旨在比较出院时患有和未患有PDA的极早产儿的肺功能。
方法
纳入入住我们新生儿重症监护病房、出生后不久需要呼吸支持且出院时接受过肺功能测试的极早产儿。在月经龄36周时需要正压支持（有创呼吸机或无氧的鼻持续气道正压通气）或补充氧气的婴儿被定义为患有支气管肺发育不良（BPD）。对每例患有PDA的极早产儿每周进行超声心动图检查以确认PDA闭合。数据进行回顾性收集。
结果
在研究期间，52例极早产儿在出院前接受了肺功能测试，其中28例患有PDA并接受了保守治疗，20例未患有PDA。另外4例接受PDA积极治疗的婴儿被排除。PDA组的胎龄显著小于无PDA组（27.1±2.0 vs. 28.6±1.6周，p = 0.009）。患有和未患有PDA的婴儿出生体重差异无统计学意义（0.98±0.26 vs. 1.12±0.26 kg，p = 0.074）。与无PDA的婴儿相比，患有PDA的婴儿中有更多例患有BPD（p = 0.002）且需要呼吸支持的时间更长（p = 0.001）。然而，在调整测试时的胎龄和月经龄后，两组出院时的功能残气量（ml/kg）相当（21.6±8.4 vs. 21.5±6.7 ml/kg，p = 0.894）。其他肺功能测试参数也相当。
结论
在除传统定义之外的BPD定义（包括需要持续气道正压通气但无需吸氧的婴儿）下，我们研究中接受PDA保守治疗的极早产儿患BPD的比例高于无PDA的婴儿。这两组出院时的肺功能测试参数和肺清除指数相当。
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