产房内正压通气时潮气容积对早产儿室管膜下出血发生的影响。
Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room.
机构信息
Centre for the Studies of Asphyxia and Resuscitation, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
出版信息
Arch Dis Child Fetal Neonatal Ed. 2019 Jan;104(1):F57-F62. doi: 10.1136/archdischild-2017-313864. Epub 2018 Jan 20.
BACKGROUND AND OBJECTIVES
Delivery of inadvertent high tidal volume (V) during positive pressure ventilation (PPV) in the delivery room is common. High V delivery during PPV has been associated with haemodynamic brain injury in animal models. We examined if V delivery during PPV at birth is associated with brain injury in preterm infants <29 weeks' gestation.
METHODS
A flow-sensor was placed between the mask and the ventilation device. V values were compared with recently described reference ranges for V in spontaneously breathing preterm infants at birth. Infants were divided into two groups: V<6 mL/kg or V>6 mL/kg (normal and high V, respectively). Brain injury (eg, intraventricular haemorrhage (IVH)) was assessed using routine ultrasound imaging within the first days after birth.
RESULTS
A total of 165 preterm infants were included, 124 (75%) had high V and 41 (25%) normal V. The mean (SD) gestational age and birth weight in high and normal V group was similar, 26 (2) and 26 (1) weeks, 858 (251) g and 915 (250) g, respectively. IVH in the high V group was diagnosed in 63 (51%) infants compared with 5 (13%) infants in the normal V group (P=0.008).Severe IVH (grade III or IV) developed in 33/124 (27%) infants in the high V group and 2/41 (6%) in the normal V group (P=0.01).
CONCLUSIONS
High V delivery during mask PPV at birth was associated with brain injury. Strategies to limit V delivery during mask PPV should be used to prevent high V delivery.
背景与目的
在产房行正压通气（PPV）时，意外输送高潮气容积（V）较为常见。动物模型研究显示，PPV 时输送高 V 与血流动力学性脑损伤相关。本研究旨在探讨出生时行 PPV 时输送高 V 是否与<29 孕周的早产儿脑损伤相关。
方法
在面罩和通气设备之间放置流量传感器。将 V 值与近期描述的出生时自主呼吸的早产儿 V 参考范围进行比较。将婴儿分为两组：V<6 mL/kg 或 V>6 mL/kg（分别为正常 V 和高 V）。出生后最初几天内使用常规超声检查评估脑损伤（如脑室出血（IVH））。
结果
共纳入 165 例早产儿，124 例（75%）输送高 V，41 例（25%）输送正常 V。高 V 和正常 V 组的平均（SD）胎龄和出生体重分别为 26（2）周和 26（1）周，858（251）g 和 915（250）g。高 V 组中 63 例（51%）婴儿诊断为 IVH，而正常 V 组中仅 5 例（13%）婴儿诊断为 IVH（P=0.008）。高 V 组中有 33/124（27%）例婴儿发生严重 IVH（III 级或 IV 级），而正常 V 组中仅 2/41（6%）例婴儿发生严重 IVH（P=0.01）。
结论
出生时行面罩 PPV 输送高 V 与脑损伤相关。应采用限制面罩 PPV 时输送 V 的策略来预防高 V 输送。
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