高持续气道正压通气并不妨碍早产绵羊出生时的心血管变化。

High-CPAP Does Not Impede Cardiovascular Changes at Birth in Preterm Sheep.

作者信息

Martherus Tessa, Crossley Kelly J, Rodgers Karyn A, Dekker Janneke, Demel Anja, Moxham Alison M, Zahra Valerie A, Polglase Graeme R, Roberts Calum T, Te Pas Arjan B, Hooper Stuart B

机构信息

Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands.

The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.

出版信息

Front Pediatr. 2021 Jan 22;8:584138. doi: 10.3389/fped.2020.584138. eCollection 2020.

Continuous positive airway pressures (CPAP) used to assist preterm infants at birth are limited to 4-8 cmHO due to concerns that high-CPAP may cause pulmonary overexpansion and adversely affect the cardiovascular system. We investigated the effects of high-CPAP on pulmonary (PBF) and cerebral (CBF) blood flows and jugular vein pressure (JVP) after birth in preterm lambs. Preterm lambs instrumented with flow probes and catheters were delivered at 133/146 days gestation. Lambs received low-CPAP (LCPAP: 5 cmHO), high-CPAP (HCPAP: 15 cmHO) or dynamic HCPAP (15 decreasing to 8 cmHO at ~2 cmHO/min) for up to 30 min after birth. Mean PBF was lower in the LCPAP [median (Q1-Q3); 202 (48-277) mL/min, = 0.002] compared to HCPAP [315 (221-365) mL/min] and dynamic HCPAP [327 (269-376) mL/min] lambs. CBF was similar in LCPAP [65 (37-78) mL/min], HCPAP [73 (41-106) mL/min], and dynamic HCPAP [66 (52-81) mL/min, = 0.174] lambs. JVP was similar at CPAPs of 5 [8.0 (5.1-12.4) mmHg], 8 [9.4 (5.3-13.4) mmHg], and 15 cmHO [8.6 (6.9-10.5) mmHg, = 0.909]. Heart rate was lower in the LCPAP [134 (101-174) bpm; = 0.028] compared to the HCPAP [173 (139-205)] and dynamic HCPAP [188 (161-207) bpm] groups. Ventilation or additional caffeine was required in 5/6 LCPAP, 1/6 HCPAP, and 5/7 dynamic HCPAP lambs ( = 0.082), whereas 3/6 LCPAP, but no HCPAP lambs required intubation ( = 0.041), and 1/6 LCPAP, but no HCPAP lambs developed a pneumothorax ( = 0.632). High-CPAP did not impede the increase in PBF at birth and supported preterm lambs without affecting CBF and JVP.

由于担心高持续气道正压（CPAP）可能导致肺过度扩张并对心血管系统产生不利影响，出生时用于辅助早产儿的CPAP限于4 - 8 cmH₂O。我们研究了高CPAP对早产羔羊出生后肺血流（PBF）、脑血流（CBF）和颈静脉压（JVP）的影响。妊娠133/146天的早产羔羊植入了流量探头和导管。出生后，羔羊接受低CPAP（LCPAP：5 cmH₂O）、高CPAP（HCPAP：15 cmH₂O）或动态HCPAP（15 cmH₂O以约2 cmH₂O/分钟的速度降至8 cmH₂O），持续30分钟。与HCPAP组[315（221 - 365）mL/分钟]和动态HCPAP组[327（269 - 376）mL/分钟]相比，LCPAP组的平均PBF较低[中位数（Q1 - Q3）；202（48 - 277）mL/分钟，P = 0.002]。LCPAP组[65（37 - 78）mL/分钟]、HCPAP组[73（41 - 106）mL/分钟]和动态HCPAP组[66（52 - 81）mL/分钟，P = 0.174]的CBF相似。在CPAP为5 [8.0（5.1 - 12.4）mmHg]、8 [9.4（5.3 - 13.4）mmHg]和15 cmH₂O [8.6（6.9 - 10.5）mmHg，P = 0.909]时，JVP相似。与HCPAP组[173（139 - 205）次/分钟]和动态HCPAP组[188（161 - 207）次/分钟]相比，LCPAP组的心率较低[134（101 - 174）次/分钟；P = 0.028]。5/6的LCPAP组羔羊、1/6的HCPAP组羔羊和5/7的动态HCPAP组羔羊需要通气或额外使用咖啡因（P = 0.082），而3/6的LCPAP组羔羊需要插管，但HCPAP组羔羊均不需要（P = 0.041），1/6的LCPAP组羔羊发生气胸，但HCPAP组羔羊均未发生（P = 0.632）。高CPAP并不妨碍出生时PBF的增加，并且在不影响CBF和JVP的情况下支持早产羔羊。