与足月或近足月婴儿相比，患有支气管肺发育不良的早产儿的膈肌厚度和移动度：一项前瞻性观察研究。
Diaphragmatic Thickness and Excursion in Preterm Infants With Bronchopulmonary Dysplasia Compared With Term or Near Term Infants: A Prospective Observational Study.
机构信息
Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto; Department of Pediatrics, Windsor Regional Hospital Metropolitan campus, Windsor, ON, Canada.
Department of Pediatrics, University Health Network, University of Toronto; Department of Pediatrics, Mount Sinai Hospital, Toronto; Department of Pediatrics, Mansoura University, Mansoura, Egypt.
出版信息
Chest. 2023 Feb;163(2):324-331. doi: 10.1016/j.chest.2022.08.003. Epub 2022 Aug 10.
BACKGROUND
Diaphragmatic atrophy associated with mechanical ventilation is reported in pediatric and adult patients, but a similar association has not been described in preterm infants with bronchopulmonary dysplasia (BPD).
RESEARCH QUESTION
Does BPD impact the diaphragm thickness (DT) and diaphragm excursion (DE) in infants born before 32 weeks' gestation compared with healthy late preterm or term infants?
STUDY DESIGN AND METHODS
In this prospective observational case-control study, DT at end of expiration (DT), DT at end of inspiration (DT), DT fraction (DTF), and DE (DE) were assessed using bedside ultrasound. Two groups were compared: infants with BPD (patients) and healthy, postmenstrual age-matched infants (control participants). To account for variations in body size between groups, diaphragmatic measurements were expressed as a ratio of body surface area (BSA). Statistical analyses were conducted using SAS software version 9.4 (SAS Institute, Inc.).
RESULTS
We enrolled 111 infants, including 56 preterm infants with BPD (mean ± SD study age, 37.7 ± 1.7 weeks) and 55 healthy control participants (mean ± SD study age, 38.1 ± 1.5 weeks). DT and DT to BSA ratio were significantly lower in the BPD group compared with the healthy control group (mean ± SD, 1.3 ± 0.4 mm vs 1.5 ± 0.4 mm [P = .01] and 7.1 ± 1.4 mm/m vs 7.8 ± 1.8 mm/m [P = .03]). DTF and DE were significantly higher in the BPD group vs the healthy control group (mean ± SD, 61.8 ± 26.0 vs 43.3 ± 19.7 [P < .01] and 6.0 ± 1.7 mm vs 4.4 ± 1.6 mm [P < .01], respectively).
INTERPRETATION
In infants with BPD, DT was significantly lower, whereas DTF and DE were significantly higher, compared with healthy, age-matched control participants. Future studies are required and should focus on describing the evolution of diaphragmatic dimensions in preterm infants with and without BPD.
TRIAL REGISTRY
ClinicalTrials.gov; No.: NCT04941963; URL: www.
CLINICALTRIALS
gov.
背景
机械通气引起的膈肌萎缩在儿科和成人患者中已有报道，但在患有支气管肺发育不良（BPD）的早产儿中尚未描述类似的关联。
研究问题
与健康的晚期早产儿或足月儿相比，BPD 是否会影响胎龄小于 32 周的婴儿的膈肌厚度（DT）和膈肌活动度（DE）？
研究设计和方法
在这项前瞻性观察性病例对照研究中，使用床边超声评估呼气末膈肌厚度（DT）、吸气末膈肌厚度（DT）、膈肌厚度分数（DTF）和 DE。将两组进行比较：BPD 患儿（患者）和健康、校正胎龄匹配的婴儿（对照参与者）。为了考虑两组之间的体型差异，膈肌测量值表示为体表面积（BSA）的比值。使用 SAS 软件版本 9.4（SAS Institute，Inc.）进行统计分析。
结果
共纳入 111 名婴儿，包括 56 名患有 BPD 的早产儿（研究时平均年龄±标准差，37.7±1.7 周）和 55 名健康对照参与者（研究时平均年龄±标准差，38.1±1.5 周）。与健康对照组相比，BPD 组的 DT 和 DT 与 BSA 比值显著降低（平均值±标准差，1.3±0.4mm 比 1.5±0.4mm [P=0.01]和 7.1±1.4mm/m 比 7.8±1.8mm/m [P=0.03]）。与健康对照组相比，BPD 组的 DTF 和 DE 显著更高（平均值±标准差，61.8±26.0 比 43.3±19.7 [P<0.01]和 6.0±1.7mm 比 4.4±1.6mm [P<0.01]）。
解释
与健康、年龄匹配的对照组相比，BPD 患儿的 DT 显著降低，而 DTF 和 DE 显著升高。未来的研究是必要的，应集中描述有和没有 BPD 的早产儿膈肌尺寸的演变。
试验注册
ClinicalTrials.gov；编号：NCT04941963；网址：www.clinicaltrials.gov。
临床试验
ClinicalTrials.gov。
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