Merth I T, de Winter J P, Zonderland H M, Borsboom G J, Quanjer P H
Dept of Paediatrics, Leiden University, The Netherlands.
Eur Respir J. 1997 Jul;10(7):1606-13. doi: 10.1183/09031936.97.10071606.
We studied whether neonatal chronic lung disease (NCLD), hyaline membrane disease (HMD) and differences in ventilatory support affected pulmonary function during the first year of life, in 65 infants born prematurely. The relationship between body weight and oxygen consumption (V'O2) was also analysed. The study comprised 14 infants without cardiorespiratory disease, 19 infants with HMD but without NCLD, 9 infants with NCLD without prior HMD, and 23 infants with NCLD following HMD. At 6 and 12 months corrected postnatal age, static respiratory system compliance (Crs) was measured by weighted spirometry and the functional residual capacity by closed circuit helium dilution (FRCHe) combined with assessment of ventilation distribution from the mixing index (MI). Ventilatory support during the first 5 days of therapy was quantified from peak inspiratory pressure (PIP), mean airway pressure (MAP) and fractional inspiratory concentration of oxygen (FI,O2). Infants with NCLD had a shorter duration of gestation and lower birth weight than those without NCLD (Wilcoxon, p=0.002 and p=0.001, respectively). Pulmonary function at 6 and 12 months corrected age was not different between NCLD infants with or without HMD at birth. Infants with NCLD had lower Crs and MI than those without NCLD (analysis of variance (ANOVA), p<0.011), but their FRCHe was not different. V'O2 adjusted for body weight was comparable in the four groups. PIP and FI,O2 were higher (Wilcoxon, p<0.01) in the NCLD infants than in those with HMD alone, but MAP was not different. Except for FI,O2, these indices were not different among the infants with NCLD. We conclude that birth weight is the major determinant of the development of neonatal chronic lung disease. At 6 and 12 months corrected age, the abnormal pulmonary function is not associated with prior hyaline membrane disease.
我们研究了65例早产婴儿中，新生儿慢性肺病（NCLD）、透明膜病（HMD）以及通气支持差异是否会影响其出生后第一年的肺功能。同时还分析了体重与耗氧量（V'O2）之间的关系。该研究包括14例无心肺疾病的婴儿、19例患有HMD但无NCLD的婴儿、9例无先前HMD的NCLD婴儿以及23例HMD后发生NCLD的婴儿。在出生后校正年龄6个月和12个月时，通过加权肺量计测量静态呼吸系统顺应性（Crs），通过闭合回路氦稀释法（FRCHe）结合混合指数（MI）评估通气分布来测量功能残气量。治疗前5天的通气支持通过吸气峰压（PIP）、平均气道压（MAP）和吸入氧分数（FI,O2）进行量化。患有NCLD的婴儿比未患NCLD的婴儿妊娠期更短、出生体重更低（Wilcoxon检验，p分别为0.002和0.001）。出生时有无HMD的NCLD婴儿在校正年龄6个月和12个月时的肺功能无差异。患有NCLD的婴儿比未患NCLD的婴儿Crs和MI更低（方差分析（ANOVA），p<0.011），但他们的FRCHe无差异。四组中经体重校正的V'O2相当。NCLD婴儿的PIP和FI,O2高于仅患有HMD的婴儿（Wilcoxon检验，p<0.01），但MAP无差异。除FI,O2外，这些指标在患有NCLD的婴儿中无差异。我们得出结论：出生体重是新生儿慢性肺病发展的主要决定因素。在校正年龄6个月和12个月时，异常肺功能与先前的透明膜病无关。
