Brennan Colleen, Ulm Lara, Julian Samuel, Hamvas Aaron, Ferkol Thomas, Hoffman Julie, Linneman Laura, Kemp James
Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
Neonatology. 2017;111(4):297-302. doi: 10.1159/000452787. Epub 2016 Dec 24.
Recovering premature infants are at risk for hypoxemia and lack of synchrony between their rib cage and abdomen due to airflow obstruction and poor respiratory compliance. Thoracoabdominal asynchrony (TAA) is a useful marker of resistive and elastic lung properties. Whether TAA predicts oxygenation is unknown.
We investigated oxyhemoglobin saturation (SpO2%) and TAA (phase angle, φ) in preterm infants with/without high-humidity nasal cannula (HHNC).
A cross-sectional observational study was conducted in 92 infants at 32 weeks' postmenstrual age. We measured SpO2% with pulse oximetry and TAA with φ via respiratory inductance plethysmography in infants (mean gestational age: 26.4 + 1.3 weeks) who required room air (n = 18) or HHNC with/without supplemental oxygen (1-5 liters per minute, FiO2 0.21-0.33, n = 74). We calculated median SpO2% from 24.7 + 10.0 min of quiet sleep and median φ from up to 60 breaths.
Infants breathing room air alone had marked TAA (φ = 83.6 + 32.9°, range: 10.9-148.5) as did those receiving varying degrees of ventilatory and oxygen support via HHNC (range of group means, φ = 47.0-90.0°). Infants breathing room air had statically greater median SpO2% than those receiving support (96.3 + 0.6% vs. 91.3 + 0.6%; ANOVA p = 0.001). SpO2% was not associated with TAA in either group (r2 = 0.09).
Recovering premature infants exhibited TAA regardless of need for ventilatory support and supplemental oxygen. TAA was not associated with SpO2% in either group. Maintenance of SpO2% does not require correction of TAA.
由于气流阻塞和呼吸顺应性差，恢复期的早产儿有低氧血症风险，且其胸廓与腹部之间缺乏同步性。胸腹部不同步（TAA）是肺阻力和弹性特性的一个有用指标。TAA是否能预测氧合情况尚不清楚。
我们研究了使用/未使用高湿度鼻导管（HHNC）的早产儿的氧合血红蛋白饱和度（SpO2%）和TAA（相位角，φ）。
对92名孕龄32周的婴儿进行了一项横断面观察性研究。我们通过脉搏血氧饱和度测定法测量SpO2%，并通过呼吸感应体积描记法测量需要室内空气（n = 18）或使用/未使用补充氧气（每分钟1 - 5升，FiO2 0.21 - 0.33，n = 74）的HHNC的婴儿（平均胎龄：26.4 + 1.3周）的TAA（φ）。我们从24.7 + 10.0分钟的安静睡眠中计算出SpO2%的中位数，并从多达60次呼吸中计算出φ的中位数。
仅呼吸室内空气的婴儿有明显的TAA（φ = 83.6 + 32.9°，范围：10.9 - 148.5），通过HHNC接受不同程度通气和氧气支持的婴儿也是如此（组均值范围，φ = 47.0 - 90.0°）。呼吸室内空气的婴儿的SpO2%中位数在统计学上高于接受支持的婴儿（96.3 + 0.6%对91.3 + 0.6%；方差分析p = 0.001）。两组中SpO2%均与TAA无关（r2 = 0.09）。
无论是否需要通气支持和补充氧气，恢复期的早产儿均表现出TAA。两组中TAA均与SpO2%无关。维持SpO2%不需要纠正TAA。
