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I型重度支气管肺发育不良婴儿的肺血管疾病与呼吸改善之间的关联。

The association between pulmonary vascular disease and respiratory improvement in infants with type I severe bronchopulmonary dysplasia.

作者信息

Carpenter Ryan J, Srdanovic Nina, Rychlik Karen, Sen Shawn K, Porta Nicolas F M, Hamvas Aaron E, Murthy Karna, Hauck Amanda L

机构信息

Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

Biostatistics Collaboration Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

出版信息

J Perinatol. 2022 Jun;42(6):788-795. doi: 10.1038/s41372-022-01386-6. Epub 2022 Apr 9.

DOI:10.1038/s41372-022-01386-6
PMID:35397644
Abstract

OBJECTIVE

To describe the association between echocardiographic measures of pulmonary vascular disease and time to respiratory improvement among infants with Type I severe bronchopulmonary dysplasia (sBPD).

STUDY DESIGN

We measured the pulmonary artery acceleration time indexed to the right ventricular ejection time (PAAT/RVET) and right ventricular free wall longitudinal strain (RVFWLS) at 34-41 weeks' postmenstrual age. Cox-proportional hazards models were used to estimate the relationship between the PAAT/RVET, RVFWLS, and the outcome: days from 36 weeks' postmenstrual age to room-air or discharge with oxygen (≤0.5 L/min).

RESULT

For 102 infants, the mean PAAT/RVET and RVFWLS were 0.27 ± 0.06 and -22.63 ± 4.23%. An abnormal measurement was associated with an increased time to achieve the outcome (PAAT/RVET: 51v24, p < 0.0001; RVFWLS; 62v38, p = 0.0006). A normal PAAT/RVET was independently associated with a shorter time to outcome (aHR = 2.04, 1.11-3.76, p = 0.02).

CONCLUSION

The PAAT/RVET may aid in anticipating timing of discharge in patients with type I severe BPD.

摘要

目的

描述I型重度支气管肺发育不良（sBPD）婴儿的肺血管疾病超声心动图测量值与呼吸改善时间之间的关联。

研究设计

我们在孕龄34 - 41周时测量了肺动脉加速时间与右心室射血时间的比值（PAAT/RVET）以及右心室游离壁纵向应变（RVFWLS）。采用Cox比例风险模型来估计PAAT/RVET、RVFWLS与以下结局之间的关系：从孕龄36周起至空气氧疗或出院时吸氧（≤0.5 L/min）的天数。

结果

对于102例婴儿，平均PAAT/RVET和RVFWLS分别为0.27±0.06和 - 22.63±4.23%。测量值异常与达到该结局的时间增加相关（PAAT/RVET：51对24，p < 0.0001；RVFWLS：62对38，p = 0.0006）。正常的PAAT/RVET与较短的达到结局时间独立相关（校正风险比 = 2.04，1.11 - 3.76，p = 0.02）。

结论

PAAT/RVET可能有助于预测I型重度BPD患者的出院时间。

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本文引用的文献

1
Prognostic Value of Right Ventricular Two-Dimensional and Three-Dimensional Speckle-Tracking Strain in Pulmonary Arterial Hypertension: Superiority of Longitudinal Strain over Circumferential and Radial Strain.右心室二维和三维斑点追踪应变在肺动脉高压中的预后价值：纵向应变优于环向和径向应变。
J Am Soc Echocardiogr. 2020 Aug;33(8):985-994.e1. doi: 10.1016/j.echo.2020.03.015. Epub 2020 Jun 10.
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Pulmonary hypertension in bronchopulmonary dysplasia.支气管肺发育不良相关肺动脉高压。
Pediatr Res. 2021 Feb;89(3):446-455. doi: 10.1038/s41390-020-0993-4. Epub 2020 Jun 10.
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Clinical Utility of Echocardiography in Former Preterm Infants with Bronchopulmonary Dysplasia.
超声心动图在支气管肺发育不良的既往早产儿中的临床应用。
J Am Soc Echocardiogr. 2020 Mar;33(3):378-388.e1. doi: 10.1016/j.echo.2019.10.012. Epub 2020 Jan 14.
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Health Care Burden of Bronchopulmonary Dysplasia Among Extremely Preterm Infants.极早产儿支气管肺发育不良的医疗负担
Front Pediatr. 2019 Dec 12;7:510. doi: 10.3389/fped.2019.00510. eCollection 2019.
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Risk Assessment and Monitoring of Chronic Pulmonary Hypertension in Premature Infants.早产儿慢性肺动脉高压的风险评估与监测
J Pediatr. 2020 Feb;217:199-209.e4. doi: 10.1016/j.jpeds.2019.10.034. Epub 2019 Nov 14.
6
Utility of echocardiography in predicting mortality in infants with severe bronchopulmonary dysplasia.超声心动图在预测严重支气管肺发育不良婴儿死亡率中的应用。
J Perinatol. 2020 Jan;40(1):149-156. doi: 10.1038/s41372-019-0508-5. Epub 2019 Sep 30.
7
Echocardiographic Assessment of Right Ventricular Afterload in Preterm Infants: Maturational Patterns of Pulmonary Artery Acceleration Time Over the First Year of Age and Implications for Pulmonary Hypertension.经胸超声心动图评估早产儿右心室后负荷：肺动脉加速时间在出生后第一年的成熟模式及其对肺动脉高压的影响。
J Am Soc Echocardiogr. 2019 Jul;32(7):884-894.e4. doi: 10.1016/j.echo.2019.03.015.
8
Normal values of the pulmonary artery acceleration time (PAAT) and the right ventricular ejection time (RVET) in children and adolescents and the impact of the PAAT/RVET-index in the assessment of pulmonary hypertension.儿童和青少年肺动脉加速时间（PAAT）及右心室射血时间（RVET）的正常值以及PAAT/RVET指数在肺动脉高压评估中的作用
Int J Cardiovasc Imaging. 2019 Feb;35(2):295-306. doi: 10.1007/s10554-019-01540-w. Epub 2019 Jan 28.
9
Future perspectives on the use of deformation analysis to identify the underlying pathophysiological basis for cardiovascular compromise in neonates.未来展望使用变形分析来识别新生儿心血管功能障碍的潜在病理生理学基础。
Pediatr Res. 2019 Apr;85(5):591-595. doi: 10.1038/s41390-019-0293-z. Epub 2019 Jan 21.
10
Pulmonary Vascular Disease in Premature Infants. Early Predictive Models of Late Respiratory Morbidity.早产儿的肺血管疾病。晚期呼吸疾病的早期预测模型。
Am J Respir Crit Care Med. 2019 Apr 15;199(8):943-944. doi: 10.1164/rccm.201810-1983ED.