早期使用肺表面活性物質(zhì)對(duì)支氣管肺發(fā)育不良嬰幼兒肺功能的影響研究
發(fā)布時(shí)間：2018-07-24 22:10
【摘要】：目的： 探討早期使用肺表面活性物質(zhì)（Pulmonary surfactant，PS)對(duì)支氣管肺發(fā)育不良（Bronchopulmonary Dysplasia,BPD）患兒嬰幼兒時(shí)期肺功能的影響，為改善BPD患兒的肺功能提供理論依據(jù)。 方法： 1.回顧性分析廣東省婦幼保健院2011年4月至2012年4月產(chǎn)科出生，并入住新生兒重癥監(jiān)護(hù)室（neonatal intensive care unit）NICU的早產(chǎn)兒的病例資料。 2.將診斷為BPD的病例，按照是否使用PS將其分為PS組及非PS組，采用電話隨訪及門(mén)診隨訪的方法，記錄兩組患兒1歲、2歲時(shí)的肺功能、身高、體重、因呼吸系統(tǒng)疾病入院次數(shù)、哮喘家族性疾病史。 3.采用潮氣呼吸的方法，在水合氯醛鎮(zhèn)靜狀態(tài)下，應(yīng)用美國(guó)Carefusiong肺功能儀，檢測(cè)兩組患兒1歲、2歲時(shí)的潮氣呼吸肺功能，將數(shù)據(jù)記錄在BPD隨訪調(diào)查表格中。 4.將所得數(shù)據(jù)在Excel表中建立數(shù)據(jù)庫(kù),使用SPSS19.0軟件對(duì)所得數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果： 1.早產(chǎn)兒一般情況： 共995例早產(chǎn)兒的病例資料，排除28天內(nèi)放棄或死亡48例病例，余947例納入研究對(duì)象，其中男564例（59.6%），女383例（40.4%），平均胎齡32.25±1.35周，平均體重2060.24±560g,發(fā)生BPD的病例共54例，BPD病例在研究期限早產(chǎn)兒的發(fā)病率為5.70%。 2.BPD患兒一般情況： 在此研究年限中，有54例BPD病例，其中搶救無(wú)效死亡4例，家屬放棄治療6例，4例合并其他嚴(yán)重疾病，剩余40例，納入隨訪研究，依據(jù)糾正胎齡36周時(shí)進(jìn)行評(píng)估，病情嚴(yán)重程度為：輕度15例（37.5%），中度16例（40.0%），重度9例（22.5%）。平均胎齡28.56±1.69周，平均出生體重1152.82±216.41g；PS組26例，非PS組14例。 3.兩組患兒出生情況及住院期間情況： PS組平均胎齡28.33±1.17周，，平均體重1070±110g，輕度BPD9例，中度BPD11例，重度BPD6例；住院期間患肺炎21例，患肺出血1例，有哮喘病家族史1例，RDS21例；平均機(jī)械通氣時(shí)間13.32±5.49d,平均吸氧時(shí)間59.04±4.32d；非PS組平均胎齡28.83±0.90周，平均體重1140±900g,輕度BPD6例，中度BPD5例，重度BPD3例，患肺炎10例，患肺出血1例，有哮喘家族史1例，RDS11例；平均機(jī)械通氣時(shí)間15.60±3.75d,平均吸氧時(shí)間62.38±4.01d； 兩組患兒病情嚴(yán)重程度無(wú)明顯差異，χ2等于0.307，p＞0.05； 兩組患兒胎齡、出生體重、住院期間合并癥無(wú)明顯差異，p＞0.05；兩組患兒的機(jī)械通氣時(shí)間、吸氧時(shí)間存在統(tǒng)計(jì)學(xué)差異，p＜0.05； 4.隨訪結(jié)果： 1歲時(shí):PS組失訪2例，非PS組失訪1例； 2歲時(shí):PS組失訪1例，非PS組失訪1例； 1歲時(shí)PS組的肺功能參數(shù)值為RR29.87±1.03次/分、TPTEF/TE26.73±0.94%、VPEF/VE28.23±0.75%、Ti0.87±0.04s、Te1.28±0.04s、VT7.96±0.53ml/kg、身高69.88±2.12cm、體重7.88±0.54kg；非PS組RR30.77±1.01次/分、TPTEF/TE25.75±0.77%、VPEF/VE27.27±0.78%、Ti0.87±0.04s、Te1.31±0.03s、VT7.53±0.51ml/kg、身高70.00±2.08cm、體重7.76±0.87kg，經(jīng)統(tǒng)計(jì)分析結(jié)果顯示：非PS組較PS組RR和Te增加，TPTEF/TE、VPEF/VE2和VT下降，P＜0.05，差異有統(tǒng)計(jì)學(xué)意義，Ti無(wú)明顯差異，P＞0.05；兩組患兒身高、體重、哮喘家族疾病史的比較，差異無(wú)明顯統(tǒng)計(jì)學(xué)意義，P＞0.05；非PS組因呼吸系統(tǒng)疾病入院次數(shù)增加，兩組差異有統(tǒng)計(jì)學(xué)意義，P＜0.05。 2歲時(shí)PS組的肺功能參數(shù)值為RR24.91±0.73次/分、TPTEF/TE27.94±0.58%、VPEF/VE29.79±0.64%、Ti1.05±0.04s、Te1.46±0.05s、VT8.76±0.53ml/kg、身高87.71±1.75cm、體重12.53±0.96kg；非PS組RR25.75±0.75次/分、TPTEF/TE27.41±0.61%、VPEF/VE28.89±0.72%、Ti1.06±0.04s、Te1.49±0.03s、VT8.30±0.48ml/kg、身高86.33±3.56cm、體重12.00±0.63kg,經(jīng)t檢驗(yàn)PS組較PS組RR增加，Te延長(zhǎng)，TPTEF/TE、VPEF/VE下降，P＜0.05，差異有統(tǒng)計(jì)學(xué)意義，VT下降，P＞0.05，差異無(wú)統(tǒng)計(jì)學(xué)意義。兩組患兒身高、體重、哮喘家族疾病史的比較，差異無(wú)明顯統(tǒng)計(jì)學(xué)意義，P＞0.05；非PS組因呼吸系統(tǒng)疾病入院次數(shù)增加，差異有統(tǒng)計(jì)學(xué)意義，P＜0.05； 結(jié)論： 1.早期使用PS替代治療可以改善BPD患兒1歲、2歲時(shí)的肺功能及減少因呼吸系統(tǒng)疾病入院次數(shù)。 2.早期使用PS替代治療對(duì)BPD患兒1歲、2歲時(shí)的身高、體重?zé)o明顯改善作用。
[Abstract]:Objective:
To explore the effect of early Pulmonary surfactant (PS) on the pulmonary function of children with bronchopulmonary dysplasia (Bronchopulmonary Dysplasia, BPD) in infants and infants, and to provide a theoretical basis for improving the pulmonary function of children with BPD.
Method:
1. a retrospective analysis of the cases of the premature infants born in the Guangdong Provincial Maternity and Child Care Center from April 2011 to April 2012 and in the neonatal intensive care unit (neonatal intensive care unit) NICU.
2. the cases diagnosed as BPD were divided into PS group and non PS group according to whether PS was used. By telephone follow-up and outpatient follow-up, the lung function, height, weight, hospitalization times of respiratory diseases and family history of asthma were recorded at the age of 1, 2 years old.
3. using the method of tidal breathing, under the sedative state of chloral hydrate, the Carefusiong lung function instrument was used to detect the tidal breathing and lung function of two groups of children at the age of 1 and 2 years, and the data were recorded in the BPD follow-up survey form.
4. Set up the database in Excel table and use SPSS19.0 software to analyze the data.
Result:
1. the general situation of preterm infants:
A total of 995 cases of preterm infants were used to exclude 48 cases of abandonment or death within 28 days. The remaining 947 were included in the study, including 564 males (59.6%), 383 women (40.4%), average fetal age of 32.25 + 1.35 weeks, average weight of 2060.24 560g, cases of BPD, and BPD disease in premature infants with the incidence of 5.70%.
General situation of children with 2.BPD:
In this study, there were 54 cases of BPD cases, of which 4 cases were invalid, 6 cases were abandoned, 4 cases were combined with other serious diseases, and the remaining 40 cases were followed up for 36 weeks. The severity of the disease was 15 cases (37.5%), moderate 16 (40%), and 9 (22.5%). The average birth weight was 1152.82 [216.41g], 26 cases in PS group and 14 cases in non-PS group.
3. the birth status and duration of hospitalization in two groups of children:
The average gestational age of group PS was 28.33 + 1.17 weeks, the average weight was 1070 + 110g, mild BPD9, moderate BPD11, severe BPD6, 21 cases of pneumonia and 1 cases of pulmonary hemorrhage during hospitalization, 1 cases of asthma family history, RDS21 cases, average mechanical ventilation time 13.32 + 5.49d, average oxygen absorption time 59.04 + 4.32d, average age of 28.83 + 0.90 weeks in non PS group, average weight 1 140 900g, mild BPD6, moderate BPD5, severe BPD3, pneumonia in 10 cases, pulmonary hemorrhage in 1 cases, with family history of asthma in 1 cases, RDS11 cases, the average mechanical ventilation time was 15.60 + 3.75d, and the average oxygen inhalation time was 62.38 + 4.01d;
There was no significant difference in severity between the two groups, _2was equal to 0.307, P > 0.05.
There was no significant difference between the two groups of gestational age, birth weight, and hospitalization, P > 0.05. The mechanical ventilation time and the oxygen absorption time in the two groups were statistically different, P < 0.05;
4. follow up results:
At 1 years of age, 2 cases were lost in group PS, and 1 cases in non PS group were lost.
At 2 years of age, 1 cases were lost in group PS, and 1 cases in non PS group were lost.
At the age of 1, the pulmonary function parameters of group PS were RR29.87 + 1.03 / min, TPTEF/TE26.73 + 0.94%, VPEF/VE28.23 + 0.75%, Ti0.87 + 0.04s, Te1.28 + 0.04s, VT7.96 + 0.53ml/kg, height 69.88 + 2.12cm, weight 7.88 + 0.54kg. G, height 70 + 2.08cm, weight 7.76 + 0.87kg, the results of statistical analysis showed that the RR and Te in the non PS group were increased, TPTEF/TE, VPEF/VE2 and VT decreased, P < 0.05, the difference was statistically significant, there was no significant difference between the two groups, and there was no significant difference between the two groups of children's height, weight, and the family history of asthma. The number of hospitalizations for respiratory diseases in group A was higher than that in group B (P < 0.05).
At the age of 2, the pulmonary function parameters of group PS were RR24.91 + 0.73 / min, TPTEF/TE27.94 + 0.58%, VPEF/VE29.79 + 0.64%, Ti1.05 + 0.04s, Te1.46 + 0.05s, VT8.76 + 0.53ml/kg, height 87.71 + 1.75cm, weight 12.53 + 0.96kg. Kg, height 86.33 + 3.56cm, weight 12 + 0.63kg, after t test, PS group was more RR than PS group, Te prolonged, TPTEF/TE, VPEF/VE decreased, P < 0.05, the difference was statistically significant, VT declined, > 0.05, the difference was not statistically significant. The difference between the two groups of children's height, weight, and the family history of asthma was no significant difference, 0.05 The number of hospitalized patients with aspiration system diseases increased, and the difference was statistically significant (P < 0.05).
Conclusion:
1. early use of PS replacement therapy can improve lung function in children with BPD at 1 years of age and 2 years of age, and reduce the number of hospitalization due to respiratory diseases.
2. the early use of PS replacement therapy did not significantly improve the height and weight of BPD children at 1 years of age and 2 years of age.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R722.6
本文編號(hào)：2142814
[Abstract]:Objective:
To explore the effect of early Pulmonary surfactant (PS) on the pulmonary function of children with bronchopulmonary dysplasia (Bronchopulmonary Dysplasia, BPD) in infants and infants, and to provide a theoretical basis for improving the pulmonary function of children with BPD.
Method:
1. a retrospective analysis of the cases of the premature infants born in the Guangdong Provincial Maternity and Child Care Center from April 2011 to April 2012 and in the neonatal intensive care unit (neonatal intensive care unit) NICU.
2. the cases diagnosed as BPD were divided into PS group and non PS group according to whether PS was used. By telephone follow-up and outpatient follow-up, the lung function, height, weight, hospitalization times of respiratory diseases and family history of asthma were recorded at the age of 1, 2 years old.
3. using the method of tidal breathing, under the sedative state of chloral hydrate, the Carefusiong lung function instrument was used to detect the tidal breathing and lung function of two groups of children at the age of 1 and 2 years, and the data were recorded in the BPD follow-up survey form.
4. Set up the database in Excel table and use SPSS19.0 software to analyze the data.
Result:
1. the general situation of preterm infants:
A total of 995 cases of preterm infants were used to exclude 48 cases of abandonment or death within 28 days. The remaining 947 were included in the study, including 564 males (59.6%), 383 women (40.4%), average fetal age of 32.25 + 1.35 weeks, average weight of 2060.24 560g, cases of BPD, and BPD disease in premature infants with the incidence of 5.70%.
General situation of children with 2.BPD:
In this study, there were 54 cases of BPD cases, of which 4 cases were invalid, 6 cases were abandoned, 4 cases were combined with other serious diseases, and the remaining 40 cases were followed up for 36 weeks. The severity of the disease was 15 cases (37.5%), moderate 16 (40%), and 9 (22.5%). The average birth weight was 1152.82 [216.41g], 26 cases in PS group and 14 cases in non-PS group.
3. the birth status and duration of hospitalization in two groups of children:
The average gestational age of group PS was 28.33 + 1.17 weeks, the average weight was 1070 + 110g, mild BPD9, moderate BPD11, severe BPD6, 21 cases of pneumonia and 1 cases of pulmonary hemorrhage during hospitalization, 1 cases of asthma family history, RDS21 cases, average mechanical ventilation time 13.32 + 5.49d, average oxygen absorption time 59.04 + 4.32d, average age of 28.83 + 0.90 weeks in non PS group, average weight 1 140 900g, mild BPD6, moderate BPD5, severe BPD3, pneumonia in 10 cases, pulmonary hemorrhage in 1 cases, with family history of asthma in 1 cases, RDS11 cases, the average mechanical ventilation time was 15.60 + 3.75d, and the average oxygen inhalation time was 62.38 + 4.01d;
There was no significant difference in severity between the two groups, _2was equal to 0.307, P > 0.05.
There was no significant difference between the two groups of gestational age, birth weight, and hospitalization, P > 0.05. The mechanical ventilation time and the oxygen absorption time in the two groups were statistically different, P < 0.05;
4. follow up results:
At 1 years of age, 2 cases were lost in group PS, and 1 cases in non PS group were lost.
At 2 years of age, 1 cases were lost in group PS, and 1 cases in non PS group were lost.
At the age of 1, the pulmonary function parameters of group PS were RR29.87 + 1.03 / min, TPTEF/TE26.73 + 0.94%, VPEF/VE28.23 + 0.75%, Ti0.87 + 0.04s, Te1.28 + 0.04s, VT7.96 + 0.53ml/kg, height 69.88 + 2.12cm, weight 7.88 + 0.54kg. G, height 70 + 2.08cm, weight 7.76 + 0.87kg, the results of statistical analysis showed that the RR and Te in the non PS group were increased, TPTEF/TE, VPEF/VE2 and VT decreased, P < 0.05, the difference was statistically significant, there was no significant difference between the two groups, and there was no significant difference between the two groups of children's height, weight, and the family history of asthma. The number of hospitalizations for respiratory diseases in group A was higher than that in group B (P < 0.05).
At the age of 2, the pulmonary function parameters of group PS were RR24.91 + 0.73 / min, TPTEF/TE27.94 + 0.58%, VPEF/VE29.79 + 0.64%, Ti1.05 + 0.04s, Te1.46 + 0.05s, VT8.76 + 0.53ml/kg, height 87.71 + 1.75cm, weight 12.53 + 0.96kg. Kg, height 86.33 + 3.56cm, weight 12 + 0.63kg, after t test, PS group was more RR than PS group, Te prolonged, TPTEF/TE, VPEF/VE decreased, P < 0.05, the difference was statistically significant, VT declined, > 0.05, the difference was not statistically significant. The difference between the two groups of children's height, weight, and the family history of asthma was no significant difference, 0.05 The number of hospitalized patients with aspiration system diseases increased, and the difference was statistically significant (P < 0.05).
Conclusion:
1. early use of PS replacement therapy can improve lung function in children with BPD at 1 years of age and 2 years of age, and reduce the number of hospitalization due to respiratory diseases.
2. the early use of PS replacement therapy did not significantly improve the height and weight of BPD children at 1 years of age and 2 years of age.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R722.6
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 翟亮;吳紅敏;魏克倫;趙詩(shī)萌;姜紅;;新生兒呼吸窘迫綜合征SP-A基因多態(tài)性的研究[J];中國(guó)當(dāng)代兒科雜志;2008年03期
2 劉冬云;吳靜;張小英;封志純;;支氣管肺發(fā)育不良新生兒支氣管肺泡灌洗液IL-8 SP-A和TGF-β1的表達(dá)[J];中國(guó)當(dāng)代兒科雜志;2010年06期
3 盧維城;向偉;吳明;鄭旭;林靜;陳興月;魏海波;詹端;李春蕾;;肺表面活性物質(zhì)蛋白B基因多態(tài)性與新生兒呼吸窘迫綜合征易感性的相關(guān)性研究[J];中國(guó)當(dāng)代兒科雜志;2012年01期
4 謝露;尹曉娟;;新生兒肺表面活性物質(zhì)研究新進(jìn)展[J];中國(guó)兒童保健雜志;2012年03期
5 甘紅英;劉學(xué)軍;;轉(zhuǎn)化生長(zhǎng)因子-β_1及其受體在肺纖維化中的作用[J];國(guó)際呼吸雜志;2006年11期
6 徐方林;陳雪禮;馮召嵐;楊洪光;李峰;鄒構(gòu);汪衛(wèi)東;;早期監(jiān)測(cè)動(dòng)脈血乳酸清除率和中心靜脈血氧飽和度對(duì)危重病患者預(yù)后的研究[J];國(guó)際檢驗(yàn)醫(yī)學(xué)雜志;2013年10期
7 張皓;肖現(xiàn)民;鄭珊;蔡映云;佘紅英;王立波;;1002例4歲以下小兒潮氣呼吸流速-容量環(huán)正常值的研究[J];臨床兒科雜志;2006年06期
8 李宜新;;嬰幼兒肺功能檢測(cè)與呼吸系統(tǒng)疾病的關(guān)系[J];臨床肺科雜志;2012年04期
9 丁悅;唐麗君;黃為民;;早產(chǎn)兒支氣管肺發(fā)育不良的診治新進(jìn)展[J];實(shí)用兒科臨床雜志;2012年02期
10 董漢權(quán);;支氣管肺炎患兒潮氣呼吸肺功能價(jià)值研究新進(jìn)展[J];齊齊哈爾醫(yī)學(xué)院學(xué)報(bào);2013年21期
本文編號(hào)：2142814
本文鏈接：http://sikaile.net/yixuelunwen/eklw/2142814.html
最近更新
教材專著
