支气管肺发育不良患儿肺炎时的心肺功能特征

Characteristics of cardiopulmonary function in preterm infants with bronchopulmonary dysplasia complicated pneumonia

摘要:

目的：探讨支气管肺发育不良（bronchopulmonary dysplasia，BPD）患儿肺炎时的心肺功能特征，以便对预后不良的患儿早期干预，从而改善生存率。方法：对2012年1月至2013年6月在深圳市儿童医院随访的BPD伴发肺炎（观察组），未并发肺炎正常随访BPD（对照1组）和健康婴幼儿（对照2组）进行心肺功能检测。心功能检测采用彩色多普勒超声诊断仪进行，以三尖瓣返流速度≥3 m/s或/和室间隔向左偏移和右心室扩张判断为肺动脉高压（pulmonary hypertension，PH）；肺功能检测采用Power-Cube超声流量仪进行。结果：①心功能：观察组（n=30）中有40%伴发PH，而对照1组（n=28）和对照2组（n=20）未有PH。观察组的收缩期肺动脉压力（systolic pulmonary artery pressure，sPAP）比对照1组、对照2组高[（32.33±2.30） vs. （22.16±3.71）和（20.51±2.30） mmHg，P<0.001]；观察组的肺血管阻力（pulmonary vascular resistance，PVR）比对照1组、对照2组的高[（2.32±0.34） vs. （2.13±0.29）和（1.71±0.24）wood unit，P<0.001]。对照1组的PVR比对照2组高（P<0.001）；观察组的肺动脉瓣血流加速时间（acceleration time，AT）、右心室射血时间（right ventricular ejection time，RVET）均比对照1组、对照2组低[（55.20±6.15） vs. （59.95±5.73）和（67.94±6.60） ms，（197.24±18.77） vs. （211.29±19.07）和（223.91±19.59） ms，P<0.001]；PH组的sPAP、PVR比非PH组的高[（42.39±1.57） vs. （25.63±5.48），（2.58±0.24） vs. （2.16±0.29），P<0.001]；PH组的AT、RVET均比非PH组低（P<0.001）。②肺功能：观察组的呼吸频率（respiratory rate，RR）比对照1组、对照2组均高[（57.43±4.21） vs. （52.36±3.69）和（28.10±2.32）次/分，P<0.001]，观察组的达峰时间比（Tpef/Te）、达峰容积比（Vpef/Ve）、75%潮气量时的呼气流速（TEF75）、25%潮气量时的呼气流速（TEF25）、25%潮气量时呼气流速/呼气峰流速（25/PF）均比对照1组、对照2组低（均P<0.001）；PH组的RR与非PH组的RR相比，没有差异（P=0.69）；PH组的Tpef/Te、Vpef/Ve、TEF75、TEF25、25/PF比非PH组低（均P<0.05）。结论：对BPD患儿肺炎时监测心肺功能，有利于了解患儿的心肺功能受损程度，同时可以早期发现PH，可能在一定程度上减少病死率。

Abstract:

Objective：To explore the characteristics of cardiopulmonary function in bronchopulmonary dysplasia（BPD） complicated with pneumonia. Methods：Seventy-eight infants from Shenzhen Chil－dren’s Hospital were recruited from January 2012 to June 2013 and were divided into observation group，control group 1（BPD without pneumonia），control group 2（health infants without BPD and pneumonia）. Cardio-pulmonary function of three groups was detected. Color Doppler ultrasonography was used to detect cardiac function and ultrasonic flow meter was used to detect lung function. The diagnosis of pulmonary hypertension（PH） was made based on the velocity of tricuspid valve regurgitation（TR）≥3 m/s，left-deviated interventricular septum and right ventricular hypertrophy with chamber dilation. Results：①cardiac function：twelve cases of PH were observed in observation group while no case in control groups. Systolic pulmonary artery pressure（sPAP） was higher in observation group than in control groups（P<0.001）. Pulmonary vascular resistance（PVR）was higher in observation group than in control groups（P<0.001）. PVR of control group 1 was higher than that of control group 2（P<0.001）. The acceleration time and right ventricular ejection time（RVET） were lower in observation group than in control groups（P<0.001）. The sPAP and PVR of PH group were higher than those of non-PH group（P<0.001）. The AT and RVET of PH group were lower than those of non-PH group（P<0.001）. ②lung function：The respiratory rate（RR） was higher in observation group than in control groups（P<0.001）. The ratio of time to peak tidal expiratory time and expiratory time（Tpef/Te），the ratio of time peak expiratory volume and expiratory volume（Vpef/Ve），expira－tory flow at 75%，25% of lung volume（TEF75，TEF25），expiratory flow at 25% of lung volume to peak expiratory flow（25/PF） of observa－tion group were lower than those of control groups（P<0.05）. There was no difference between PH group and non-PH group in RR（P=0.69）. The Tpef/Te，Vpef/Ve，TEF75，TEF25，25/PF of PH group were lower than those of non-PH group（P<0.05）. Conclusion：Moni－toring cardiopulmonary function is beneficial for BPD patients complicated with pneumonia，through which patients can know cardiopul－monary injury degree，detect PH at early stage and reduce mortality to some extent.