本文關(guān)鍵詞：潮氣呼吸流速—容量環(huán)對支氣管肺發(fā)育不良患兒肺功能的監(jiān)測　出處：《重慶醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 潮氣呼吸流速-容量環(huán) 支氣管肺發(fā)育不良 功能殘氣量 肺清除指數(shù) 早產(chǎn)兒

【摘要】：目的：探討潮氣呼吸流速-容量環(huán)（TBFVL）結(jié)合功能殘氣量（FRC）和肺清除指數(shù)（LCI）對支氣管肺發(fā)育不良（BPD）患兒肺功能的監(jiān)測作用。 方法：2011年1月-2012年10月在深圳市兒童醫(yī)院新生兒科及新生兒重癥監(jiān)護病房住院及門診隨訪的無嚴重心肺疾病的非BPD早產(chǎn)兒113例為非BPD早產(chǎn)兒組（對照組），BPD早產(chǎn)兒106例為觀察組，根據(jù)BPD的分度標準分為輕、中、重三組（48例，42例，，16例）。在校正胎齡（PMA）44周各組進行潮氣呼吸肺功能檢測，各組患兒檢測時無呼吸道癥狀。潮氣呼吸肺功能指標包括TBFV環(huán)形態(tài)和參數(shù)數(shù)值及FRC、LCI數(shù)值，將各指標與BPD嚴重程度進行相關(guān)性分析，在校正胎齡76周時對各組患兒肺功能進行復(fù)查，分析各組TBFV環(huán)形態(tài)及數(shù)值變化。 結(jié)果：（1）TBFVL形態(tài)分析：BPD組呼氣降支陡峭，PMA44周時輕度BPD組呼氣降支斜率較非BPD早產(chǎn)兒組增大，中重度BPD組呼氣降支明顯向容量軸凹陷；重度BPD組TPEF、TPIF均明顯增加。PMA76周時輕度BPD組呼氣降支與非BPD早產(chǎn)兒組相似，均較平緩，中度BPD組呼氣降支稍陡峭，重度BPD組呼氣降支有凹陷；重度BPD組TPEF較其余各組明顯升高。 （2）肺功能參數(shù)分析：PMA44周時中、重度BPD組RR、TPIF【分別為(56.79±8.91)、(58.11±10.12)次/min，(60.91±20.54)、(75.30±14.43)ml/s】比非BPD早產(chǎn)兒組【(49.91±12.78)次/min、(52.39±20.12)ml/s】高，P0.05，且重度BPD組TPIF比輕度BPD組TPIF高，P0.05，輕度BPD組RR、TPIF【分別為(52.97±12.59)次/min、(55.27±21.61)ml/s】與非BPD早產(chǎn)兒組無統(tǒng)計學(xué)差異，P0.05。中、重度BPD組Tpef/Te比非BPD早產(chǎn)兒組【(20.36%±9.15%)、(18.07%±5.28%)比(28.79%±9.06%)】低，P0.01，且重度BPD組Tpef/Te比輕度BPD組(24.29%±12.80%)低，P0.05，輕度BPD組Tpef/Te與非BPD早產(chǎn)兒組無統(tǒng)計學(xué)差異，P0.05。TPEF重度BPD組【(85.33±11.48)ml/s】比非BPD早產(chǎn)兒組、輕度BPD組【(58.55±23.09)、(56.03±24.93)ml/s】均高，均P0.05。TV各組間無統(tǒng)計學(xué)差異【分別為(24.80±9.14)、(23.37±8.78)、(22.17±8.67)和(22.05±3.36)ml，均P0.05】。中、重度BPD組FRC均比非BPD早產(chǎn)兒組【(15.37±3.14)、(15.06±3.85)比(19.96±5.04)ml/kg】低， P0.01，輕度BPD組【(17.74±5.47)ml/kg】FRC與非BPD早產(chǎn)兒組無統(tǒng)計學(xué)差異，P0.05；LCI則只有中度BPD組比非BPD早產(chǎn)兒組高【(9.93±3.34)比(8.36±2.78)】，P0.05。PMA76周時,輕、中、重BPD組Tpef/Te【20.80%±3.03%、18.07%±2.98%、16.73±2.50%】比非BPD早產(chǎn)兒組(36.06±5.06)低(P0.05)，LCI【(9.42±1.61)、(10.33±1.72)、(10.89±1.88)】比非BPD早產(chǎn)兒組(7.98±1.61)高(P0.05)，F(xiàn)RC除輕度BPD【(21.14±2.82)ml/kg】組外，中、重度BPD組【(19.26±2.16)、(19.19±2.15)ml/kg】均比非BPD早產(chǎn)兒組低(P0.05),除重度BPD組外，輕、中度BPD組潮氣量【(71.40±6.32)、(70.14±8.60)ml】均低于非BPD早產(chǎn)兒組【(75.79±5.64) ml】(P0.05)，TPEF仍只有重度BPD組高于非BPD早產(chǎn)兒組【(162.90±16.50)比(133.70±21.62)ml/s，P0.05】，輕、中、重BPD組RR、TPIF均與非BPD早產(chǎn)兒組無統(tǒng)計學(xué)差異(P0.05)。 （3）兩次測試結(jié)果比較：各組RR在PMA76周時比PMA44周時低【分別為非BPD早產(chǎn)兒組：(36.06±5.06)比(49.91±12.78)次/min，輕度BPD組：(36.50±6.79)比(52.97±12.59)次/min，中度BPD組：(37.05±5.70)比(56.79±8.91)次/min，重度BPD組：(38.61±6.17)比(58.11±10.12)次/min,均P0.05】，各組TPIF、TPEF和FRC在PMA76周時比PMA44周時高【非BPD早產(chǎn)兒組分別為(133.70±21.62)比(52.39±20.12)ml/s、(141.08±24.79)比(58.55±23.09)ml/s和(21.72±3.12)比(19.96±5.04)ml/kg；輕度BPD組分別為(129.33±17.25)比(55.27±21.61)ml/s、(147.02±22.28)比(56.03±24.93)ml/s和(21.14±2.82)比(17.74±5.47)ml/kg；中度BPD組分別為(126.52±19.73)比(60.91±20.54)ml/s、(149.87±22.24)比(69.59±33.17)ml/s,(19.26±2.16)比(15.37±3.14)ml/kg；重度BPD組分別為(124.53±20.62)比(75.30±14.43)ml/s，(162.90±16.50)比(85.33±11.48)ml/s和(19.19±2.15)比(15.06±3.85)ml/kg】，均P0.05；非BPD早產(chǎn)兒組、輕度BPD組、中度BPD組Tpef/Te在PMA76周時比PMA44周時低【分別為(23.17%±4.32%)比(28.79%±9.06%)、(20.80%±3.03%)比(24.29%±12.80%)和(18.07%±2.98%)比(20.36%±9.15%)】，P0.05，重度BPD組無明顯差異【(16.73%±2.50%)比(18.07%±5.28%)，t=1.712，P=0.113】；各組LCI在PMA44周和PMA76周時無明顯差異【分別為(7.98±1.61)比(8.36±2.78)、(9.42±1.61)比(9.01±3.22)、(10.33±1.88)比(9.93±3.34)和(10.89±1.88)比(10.31±2.85)，均P0.05】。 （4）各參數(shù)與BPD嚴重程度相關(guān)性分析：PMA44周時RR、Tpef/Te、TPEF、TPIF、TEF75、FRC與BPD嚴重程度明顯相關(guān)(均P0.05),TV、LCI與BPD嚴重程度相關(guān)性不明顯(均P0.05)。PMA76周時Tpef/Te、TEF75、FRC、LCI與BPD嚴重程度明顯相關(guān)(均P0.05),RR、TV、TPIF、TPEF與BPD嚴重程度相關(guān)性不明顯(均P0.05)。 結(jié)論：TBFVL可直觀反映不同程度支氣管肺發(fā)育不良患兒潮氣呼吸肺功能特征。TBFVL結(jié)合FRC、LCI能較全面、系統(tǒng)的反映BPD患兒的大小氣道、肺組織彈性的異常及隨年齡增加肺發(fā)育恢復(fù)狀況，可用于BPD患兒肺發(fā)育的監(jiān)測。
[Abstract]:Objective: To investigate the tidal flow volume loop (TBFVL) combined with functional residual capacity (FRC) and lung clearance index (LCI) of bronchopulmonary dysplasia (BPD) monitoring of pulmonary function in children.
Methods: January 2011 October -2012 in newborn and pediatric Shenzhen city children's Hospital ICU inpatient and outpatient follow-up without serious heart and lung disease in preterm infants and 113 cases of non BPD non BPD preterm infants group (control group), BPD of 106 cases of the observation group, according to the standard of BPD is divided into light. Three group (48 cases, 42 cases, 16 cases). The corrected gestational age (PMA) 44 weeks of tidal breathing lung function test, serum detection without respiratory symptoms. Pulmonary function index including tidal pattern and parameters of TBFV ring and FRC LCI numerical value, the index and the severity of BPD through correlation analysis, review of lung function in children with groups in the corrected gestational age of 76 weeks, were analyzed for TBFV ring shape and numerical changes.
Results: (1) TBFVL morphological analysis: BPD group breath descending steep, mild BPD group at PMA44 weeks of expiratory slope than that in non BPD group increased in premature infants, severe BPD group breath descending significantly to the capacity of shaft sag; severe BPD group TPEF, TPIF were significantly increased at.PMA76 weeks of mild BPD group call drop gas with non BPD preterm infants were similar, is fairly gentle, moderate BPD group breath descending slightly steep, severe BPD group breath descending depression; severe BPD group TPEF was significantly increased compared with the rest of the group.
(2)鑲哄姛鑳藉弬鏁板垎鏋愶細PMA44鍛ㄦ椂涓

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