本文關(guān)鍵詞：不同胎齡早產(chǎn)兒潮氣呼吸肺功能的測定及分析　出處：《鄭州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 肺功能 新生兒 早產(chǎn) 影響因素 隨訪

【摘要】：呼吸系統(tǒng)疾病是早產(chǎn)兒最常見的疾病之一，也是其重要發(fā)病和死亡原因，近年來其患病率一直居高不下。隨著圍生醫(yī)學(xué)的快速發(fā)展及醫(yī)療水平的不斷提高，我國早產(chǎn)兒（premature infant,PI）發(fā)生率已上升至8.1%，早產(chǎn)兒的存活率也明顯提高。由于其肺部發(fā)育不完善、體重低下、免疫力低下等因素，極易出現(xiàn)呼吸系統(tǒng)疾病，越來越多的臨床研究表明早產(chǎn)兒呼吸系統(tǒng)疾病的發(fā)病率在逐年增加，因其住院時(shí)間較長，花費(fèi)高，給家庭、社會帶來巨大的心理負(fù)擔(dān)和經(jīng)濟(jì)負(fù)擔(dān)，近年來引起社會的高度關(guān)注。 肺功能檢查不僅能用于鑒別呼吸系統(tǒng)疾病的性質(zhì)、判斷疾病的嚴(yán)重程度，在評價(jià)藥物治療效果及協(xié)助呼吸機(jī)參數(shù)的選擇上也起到至關(guān)重要的作用，已成為預(yù)測疾病及監(jiān)控病情的重要組成部分，廣泛應(yīng)用于呼吸內(nèi)科，兒科，婦產(chǎn)科，胸外科，職業(yè)病評定等多個(gè)領(lǐng)域。肺功能各參數(shù)的正常值在診治疾病、判斷療效中起到不可或缺的參考作用。常規(guī)的肺功能測定需要患者的積極配合，這限制了其在兒童以及在新生兒的應(yīng)用。而檢查潮氣呼吸肺功能僅需平靜呼吸，因此適用于新生兒。新生兒肺功能檢測從上世紀(jì)50年代開始出現(xiàn)于臨床，由于檢測技術(shù)落后、新生兒潮氣量小、檢測結(jié)果準(zhǔn)確度差等原因使其未能順利開展。隨著計(jì)算機(jī)的快速發(fā)展，臨床已開始廣泛開展新生兒肺功能的研究，但目前國內(nèi)對早產(chǎn)兒肺功能的研究仍較少，而且缺乏早產(chǎn)兒肺功能的隨機(jī)對照研究。 目的 通過對住院期間無呼吸系統(tǒng)疾病的不同胎齡早產(chǎn)兒動態(tài)進(jìn)行肺功能檢測，了解其生后早期潮氣呼吸肺功能及重要呼吸參數(shù)的特點(diǎn)；對出院后的早產(chǎn)兒進(jìn)行隨訪，探討其校正胎齡40周時(shí)潮氣呼吸肺功能及重要呼吸參數(shù)的變化，比較其與對照組肺功能之間的差異，并對其影響因素進(jìn)行分析，以提高臨床醫(yī)師對早產(chǎn)兒肺功能的認(rèn)識，并提供臨床正常參考值。 方法 1研究對象分組 研究對象來源于2013年2月至2013年10月在鄭州大學(xué)第三附屬醫(yī)院新生兒科住院的75例早產(chǎn)兒（premature infant,PI），均為適于胎齡兒，剖宮產(chǎn)出生，出生時(shí)Apgar評分7分；選擇同期收住的足月兒（term infant,TI）55例為對照組，剖宮產(chǎn)出生，胎齡（gestational age，GA）39~40周。 排除標(biāo)準(zhǔn)：1.受試時(shí)有呼吸窘迫等呼吸道癥狀；2.母親有吸煙史；3.一級親屬中有哮喘史；4.存在對肺功能有影響的先天性疾�。�5.受試前曾應(yīng)用對肺功能有影響的藥物。2方法 本次研究選用潮氣呼吸法，在新生兒藥物睡眠（藥物選用5％水合氯醛0.5～0.8ml／kg灌腸或口服）或者自然睡眠、平靜呼吸的狀態(tài)下，將面罩扣緊于患兒口鼻，通過流速傳感器把流速信號積分成容量，電腦可顯示出測得值。測定前常規(guī)記錄新生兒的胎齡、性別，測量其身長及體質(zhì)量，實(shí)驗(yàn)組和對照組在生后3-5天分別測定其潮氣呼吸肺功能。每人測試3次，由電腦自動計(jì)算其平均值。可測定的主要參數(shù)有：潮氣量(Tidal volume,VT)、每公斤體重潮氣量(Tidalvolume/kg,VT/kg)、吸氣時(shí)間(Inspiratory time,tI)、呼氣時(shí)間(Expiratory time,tE)、吸呼比(Ratio tI to tE,tI/tE)、呼吸頻率(Respiratory rate,RR)、達(dá)峰時(shí)間(Time toPTEF,TPEF)、達(dá)峰時(shí)間比(Ratio of TPEF and total tE,TPEF/tE)、達(dá)峰容積(Expiratory volume at PTEF,VPEF)、達(dá)峰容積比(Ratio of VPEF and totalVE,VPEF/VE）。 對實(shí)驗(yàn)組進(jìn)行隨訪，校正胎齡40周時(shí)對其再次進(jìn)行潮氣呼吸肺功能的測定，，采用統(tǒng)計(jì)學(xué)方法進(jìn)行分析，探討不同胎齡早產(chǎn)兒生后早期及校正胎齡40周時(shí)主要呼吸參數(shù)的變化及影響因素，并比較其與足月兒肺功能之間的差異。 結(jié)果 1.生后3-5天時(shí)各組之間肺功能主要參數(shù)的差異 p1組及p2組的胎齡較小，出生體質(zhì)量低，肺部發(fā)育不完善，TPEF、TPEF/tE、VPEF、VPEF/VE值均明顯低于TI組，RR值則高于TI組（均P0.05）；p3組與TI組除tI、TPEF、TPEF/tE以外，其余肺功能參數(shù)的差異無統(tǒng)計(jì)學(xué)意義（P0.05）；p1組與p3組相比，tI、TPEF、TPEF/tE、VPEF、VPEF/VE及RR值的差異有統(tǒng)計(jì)學(xué)意義（P0.05）；p1組與p2組相比，TPEF、TPEF/tE、VPEF及VPEF/VE的差異有統(tǒng)計(jì)學(xué)意義（P0.05）；p2組除RR、tI及TPEF外，其余肺功能參數(shù)與p3組相比差異無統(tǒng)計(jì)學(xué)意義（P0.05）。 2.早產(chǎn)兒校正胎齡40周時(shí)各組之間肺功能參數(shù)的差異 與TI組相比較，p1組校正胎齡40周時(shí)TPEF/tE、VPEF/VE、TPEF、VPEF均明顯低于TI組，RR明顯高于TI組（均P0.05），p2組TPEF/tE、VPEF/VE、TPEF、VPEF均明顯低于TI組（P0.05），其它指標(biāo)差異不具有顯著性，p3組與TI組相比較，僅表現(xiàn)為TPEF、TPEF/tE低于TI組（P0.05），其余肺功能參數(shù)的差異均無統(tǒng)計(jì)學(xué)意義；p1組與p3組相比較，前者TPEF/tE、VPEF/VE、TPEF及VPEF值均低，RR則高于后者，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；p1組與p3組相比較，前者TPEF/tE、VPEF/VE、TPEF及VPEF值均低，RR則高于后者，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；p1組與p2組相比較，僅表現(xiàn)為VPEF值低于后者，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；p2組除TPEF低于p3組，其余肺功能參數(shù)差異無統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論 1.潮氣呼吸法適用于測定新生兒呼吸力學(xué)指標(biāo)。 2.新生兒潮氣呼吸肺功能主要受胎齡、體質(zhì)量的影響，早產(chǎn)兒有明顯的潮氣呼吸肺功能受損，胎齡越小，以上變化越明顯。
[Abstract]:Respiratory disease is one of the most common disease in preterm infants, but also an important cause of morbidity and mortality in recent years, the prevalence rate has been high. With the rapid development of perinatal medicine and medical level unceasing enhancement, our country in preterm infants (premature infant, PI) incidence rate has risen to 8.1%, the survival rate of premature infants increased significantly because of their lung development is not perfect, low weight, low immunity and other factors, prone to respiratory diseases, more and more clinical studies showed that the incidence rate of premature infant respiratory diseases increased year by year, because of the long time of hospitalization, cost is high, to the family, society brings great psychological burden and economic burden caused by height social concern in recent years.
Pulmonary function tests can be used not only to identify the nature of the respiratory system disease, severity of disease, drug treatment and assist in the evaluation of the effect of ventilator parameters selection also plays an important role, has become an important part of the prediction and monitoring of disease condition, widely used in respiratory medicine, pediatrics, Obstetrics and Gynecology, Department of thoracic surgery. Many areas of occupation disease assessment. The parameters of the normal value of pulmonary function in the diagnosis and treatment of diseases, plays an indispensable role in reference to judge the curative effect. Regular lung function determination need the active cooperation of the patients, which limits its application in children and in the newborn. And check the tidal breathing lung function only quiet breathing, so suitable for newborn neonatal lung function detection. From the beginning of the last century in 50s in the clinic, because the detection technology is backward, neonatal tidal volume small, the accuracy of the test result because of poor With the rapid development of computers, the research of neonatal lung function has been carried out extensively. However, there are few studies on the lung function of premature infants in China, and there is a lack of randomized controlled study on the lung function of premature infants.
objective
Pulmonary function was tested by dynamic different gestational age in preterm infants without respiratory disease during hospitalization, to understand the characteristics of early postnatal tidal breathing lung function and respiratory parameters; follow-up of discharged premature infants, explore the corrected gestational age changes of tidal breathing lung function and important respiratory parameters at 40 weeks, compared to the the difference between group and pulmonary function control, and analyze the influencing factors, to improve the understanding of pulmonary function of premature infants, and provide clinical reference value.
Method
1 group of research objects
Study from February 2013 to October 2013 of 75 premature infants in Pediatric Hospital Affiliated Hospital of Zhengzhou University third (premature infant, PI), are appropriate for gestational age, Caesarean birth, birth Apgar score of 7; full-term infants admitted during the same period (term infant, TI) 55 cases of the control group. Caesarean birth, gestational age (gestational, age, GA) 39~40 weeks.
Exclusion criteria: 1., there were respiratory symptoms such as respiratory distress and other respiratory symptoms. 2. of the mothers had smoking history, 3. had first-degree relatives of asthma, 4. had congenital diseases affecting lung function, and 5. had used.2 for lung function before the trial.
This study selected tidal breathing method in neonatal sleep drugs (drug with 5% chloral hydrate 0.5 ~ 0.8ml / kg enema or oral) or natural sleep, quiet breathing condition, the mask to fasten the mouth and nose, through the flow velocity sensor signal integral capacity, computer can display the measured value determination. The routine records in gestational age, gender, body length and body weight measurement, the experimental group and the control group to determine the tidal breathing lung function in 3-5 days after birth. Each test 3 times, the average value was calculated automatically by the computer. Can be used in the determination of main parameters are: tidal volume (Tidal volume VT) body weight, tidal volume per kilogram (Tidalvolume/kg, VT/kg), inspiratory time (Inspiratory time, tI (Expiratory), expiratory time time, tE), breathing (Ratio tI to tE, more than tI/tE), respiratory rate (Respiratory rate, RR), time to peak (Time, toPTEF, TPEF), peak Time ratio (Ratio of TPEF and total tE, TPEF/tE), peak volume (Expiratory volume at PTEF, VPEF), and peak volume ratio.
Follow up the experimental group, the corrected gestational age of 40 weeks were measured again on the tidal breathing lung function, using statistical methods to analyze, explore the changes and influence factors of different gestational age of premature infants and the corrected gestational age of 40 weeks the main respiratory parameters, and compare the difference between the full-term infants' lung function.
Result
Difference of major pulmonary function parameters between each group after 1. birth and 3-5 days
Smaller gestational age in P1 group and P2 group, low birth weight, pulmonary hypoplasia, TPEF, TPEF/tE, VPEF, VPEF/VE values were significantly lower than those of TI group, the RR value is higher than that of TI group (P0.05); P3 group and TI group in tI, TPEF, TPEF/tE, no statistically significant difference in the rest of the lung function parameters (P0.05); group P1 compared with group P3, tI, TPEF, TPEF/tE, VPEF, the difference was statistically significant VPEF/VE and RR values (P0.05); group P1 compared with group P2, TPEF, TPEF/tE, there was a significant difference in VPEF and VPEF/VE (P0.05); P2 group in addition to RR, tI and TPEF, no significant remaining lung function parameters compared with the P3 group difference (P0.05).
Difference of pulmonary function parameters between 2. preterm infants at 40 weeks of correction of fetal age
涓嶵I緇勭浉姣旇緝,p1緇勬牎姝ｈ儙榫

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