Fajardo C, Alvarez J, Wong A, Kwiatkowski K, Rigatto H
Department of Pediatrics, University of Manitoba, Canada.
Early Hum Dev. 1993 Mar;32(2-3):197-206. doi: 10.1016/0378-3782(93)90012-j.
We tested the hypotheses that (1) preterm infants with bronchopulmonary dysplasia (BPD) have an increased incidence of obstructive apneas as compared to those without BPD (control) and (2) the respiratory pattern during obstructive apneas may be associated with more pronounced hypoventilation. Ventilation was measured with a flow-through system. We examined 2929 total apneas in 12 infants with BPD and 4366 apneas in 12 control infants matched for study weight (1.51 +/- 0.11 kg in the BPD group and 1.62 +/- 0.12 kg in the control group, P = 0.6) and for postconceptional age (33.3 +/- 0.8 weeks in the BPD group compared with 33.4 +/- 0.7 weeks in the control group, P = 0.6). The incidence of central apneas predominated in the BPD group (2551/2929, 87%) and in the control group (4188/4366, 96%). Obstructive apneas were more frequent in the BPD group (378/2929, 13%) than in the control group (178/4366, 4%, P = 0.004). The increased incidence of obstructive apneas in infants with BPD was observed in Quiet sleep (9.1 vs. 1.6%, P = 0.03) and in REM sleep (14.2 vs. 3.6%, P = 0.009). This increased incidence of obstructive apneas was applicable to short apneas (< 10 s, 10.9 vs. 2.7%, P = 0.003) and long apneas (> 10 s, 27.5 vs. 16.4%, P = 0.01). There were no significant changes in ventilatory pattern that could be uniquely attributed to one type of apnea. The findings suggest: (1) the great variability in the incidence of obstructive apneas reported in the literature relates, at least in part, to the clinical status of the infants and (2) ventilatory pattern is not a useful predictor of either type of apnea.
（1）与无支气管肺发育不良（BPD）的早产儿（对照组）相比，患有BPD的早产儿阻塞性呼吸暂停的发生率更高；（2）阻塞性呼吸暂停期间的呼吸模式可能与更明显的通气不足有关。采用流通系统测量通气情况。我们检查了12例患有BPD的婴儿中的2929次总呼吸暂停，以及12例与研究体重匹配（BPD组为1.51±0.11kg，对照组为1.62±0.12kg，P = 0.6）和孕龄匹配（BPD组为33.3±0.8周，对照组为33.4±0.7周，P = 0.6）的对照婴儿中的4366次呼吸暂停。中枢性呼吸暂停的发生率在BPD组（2551/2929，87%）和对照组（4188/4366，96%）中占主导。BPD组的阻塞性呼吸暂停比对照组更频繁（378/2929，13% 对比 178/4366，4%，P = 0.004）。在安静睡眠（9.1% 对比 1.6%，P = 0.03）和快速眼动睡眠（14.2% 对比 3.6%，P = 0.009）中均观察到患有BPD的婴儿阻塞性呼吸暂停发生率增加。这种阻塞性呼吸暂停发生率的增加适用于短呼吸暂停（<10秒，10.9% 对比 2.7%，P = 0.003）和长呼吸暂停（>10秒，27.5% 对比 16.4%，P = 0.01）。通气模式没有显著变化可唯一归因于某一种类型的呼吸暂停。研究结果表明：（1）文献中报道的阻塞性呼吸暂停发生率的巨大差异至少部分与婴儿的临床状况有关；（2）通气模式不是任何一种类型呼吸暂停的有用预测指标。
