目的 研究不同布地奈德雾化吸入策略对中度支气管肺发育不良(BPD)早产儿生后矫正胎龄12月内生活质量的影响。方法 收集扬州大学附属连云港市妇幼保健院2016年9月1日-2019年9月1日新生儿重症监护室出院的中度BPD患儿31例,采用前瞻性方法,出院后均以 0.9%氯化钠2 ml+布地奈德1 ml雾化吸入 bid×1月。然后根据随机方式,将出院1月后～矫正胎龄12月时雾化吸入策略分为3种:长期吸入组(n=11)、按需吸入组(n=10)及无吸入组(n=10)。分析雾化吸入策略对中度BPD患儿矫正胎龄12月内呼吸道症状如喘息及发热、上感及肺部感染频次、入住儿科重症监护室(PICU)次数及矫正胎龄1月及12月潮气肺功能指标的影响。结果 与按需吸入组及无吸入组相比,长期吸入组患儿1年内发生喘息及发热、肺部感染频次、入住PICU次数及健康状态时活动后气急之间差异均无统计学意义(P＞0.05),但长期吸入组患儿上感次数明显减少(P＜0.05)。31例中度BPD患儿矫正胎龄12月后,三组间潮气量(VT/kg)、 吸呼比(Ti/Te)、达峰时间比(TPTEF/TE)及呼出25%潮气容积时段的平均呼气流量(TEF75)差异均无统计学意义(P＞0.05);与按需吸入组及无吸入组相比,长期吸入组矫正胎龄12月时达峰容积比(VPEF/VE)明显升高(F＝36.36,P＜0.05);长期吸入组矫正胎龄12月VPTEF/VE较1月时明显升高,差异具有统计学意义(P＜0.05)。结论 长期布地奈德吸入策略可减少中度BPD患儿矫正胎龄12月内上呼吸道感染发生频次,改善VPTEF/VE,但对呼吸系统症状急性加重或恶化的保护作用有限。
Abstract
Objective To study the effect of different budesonide inhalation strategies on the quality of life of preterm infants with moderate bronchopulmonary dysplasia(BPD) within the corrected age of 12 months old after birth. Methods Infants with moderate BPD, who were discharged from Neonatal Intensive Care Unit(NICU) of Lianyungang Maternal and Child Healthcare Hospital Affiliated to Yangzhou University from September 1st, 2016 to September 1st, 2019, were enrolled in this study.All the infants were inhaled with 0.9% sodium chloride(2 ml) and budesonide(1 ml) for 1 month after discharge from hospital.According to the atomization inhalation strategy, infants were randomly divided into three groups: long-term inhalation group(n=11), on-demand inhalation group(n=10) and none-inhalation group(n=10).The effects of atomization inhalation strategy on respiratory tract infection symptoms such as wheezing and fever, frequency of upper respiratory tract infection, pneumonia, times of admission to PICU, and tidal pulmonary function at corrected age of 1 and 12 months were analyzed retrospectively. Results There were no significant differences in frequencies of wheezing, fever and pneumonia, the times of admission to PICU and wheezing after physical activity within one year among long-term inhalation group, on-demand inhalation group and none-inhalation group(P>0.05), but the frequency of upper respiratory tract infection in the long-term inhalation group was significantly reduced(P<0.05).At the correct gestational age of 12 months, there were no significant differences in the tidal volume(VT/kg), inspiratory/expiratory ratio(Ti/Te), ratio of TPEF and TE(TPTEF/TE) and mean exhaled expiratory flow in the period of 75% tidal volume(TEF75) among the three groups(P>0.05).Compared with on-demand inhalation group and non-inhalation group, the ratio of VPEF and VE(VPEF/VE) in the long-term inhalation group was significantly higher at the corrected gestational age of 12 months(F=36.36, P＜0.05).The VPEF/VE at corrected gestational age of 12 months significantly increased than that at corrected gestational age of 1 month in long-term inhalation group(P<0.05). Conclusion Long-term budesonide inhalation strategy reduces the frequency of upper respiratory tract infection and improve VPEF/VE in children with moderate BPD during corrected age of 12 months, but has limited protection against acute aggravation or worsening of respiratory symptoms.
关键词
支气管肺发育不良 /
布地奈德 /
雾化吸入 /
长期影响
Key words
bronchopulmonary dysplasia /
budesonide /
aerosol inhalation /
long-term effect
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Jo HS,Cho KH,Cho SI,et al.Recent changes in the incidence of bronchopulmonary dysplasia among very-low-birth-weight infants in Korea [J].J Korean Med Sci,2015,30(suppl1):81-87.
[2] Zhong YY, Li JC, Liu YL,et al.Early intratracheal administration of corticosteroid and pulmonary surfactant for preventing bronchopulmonary dysplasia in preterm infants with neonatal respiratory distress syndrome: a meta-analysis[J].Curr Med Sci,2019,39(3):493-499.
[3] 陈奕江,张水堂,杨润娜.生后7天内气道内应用布地奈德对早产儿支气管肺发育不良发生率影响的系统评价和Meta分析[J].中国循证儿科杂志,2016,11(4):259-264.
[4] Zheng Y, Xiu W, Lin Y,et al.Long-term effects of the intratracheal administration of corticosteroids for the prevention of bronchopulmonary dysplasia: a meta-analysis[J].Pediatr Pulmonol, 2019, 54(11):1722-1734.
[5] 申昆玲,邓力,李云珠,等.糖皮质激素雾化吸入疗法在儿科应用的专家共识(2014年修版)[J].临床儿科杂志, 2014, 32(6): 504-511.
[6] Northway WH,Rosan RC, Porter DY.Pulmonary disease following respirator therapy of hyaline-membrane disease.Bronchopulmonary dysplasia.[J].N Ensl J Med,1967,276(7):357-368.
[7] 刘敬.早产儿支气管肺发育不良研究中存在的问题与思考[J].中国儿童保健杂志, 2019, 27(10): 1045-1058.
[8] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2011:416-422.
[9] 江苏省新生儿重症监护病房母乳质量改进临床研究协作组.多中心回顾性分析及低及超低出生体重儿支气管发育不良的临床特点及高危因素[J].中华儿科杂志,2019,57(1):33-39.
[10] Perez PG,Nanarro MM.Bronchopulmonary dysplasia and prematurity.Short-and long-term respiratory changes[J].An Pediatr(Barc),2010,72(1):79.e1-16.
[11] VanMastrigt E, Kakar E, Ciet P, et al.Structural and functional ventilatory impairment in infants with severe bronchopulmonary dysplasia[J].Pediatr Pulmonol,2017,52(8):1029-1037.
[12] 林燕,赖华,徐若梅.支气管肺发育不良患儿与生后1年内下呼吸道感染[J].四川医药,2010,32(2):182-183.
[13] 张亚芥,潘家华,代传林,等.早产儿-支气管肺发育不良-喘息综合征患儿的临床及肺功能特点[J].中华实用儿科杂志,2018,33(14):1083-1087.
[14] Hayes D, Meadown JT, Murphy BS, et al.Pulmonary function outcomes in bronchopulmonary dyaplasia through childhood and into adulthood: implications for primary care[J].Prim Care Respir J,2011,20(2):128-133.
[15] 齐利峰,麦玉珍,姚芳,等.支气管肺发育不良合并肺动脉高压危险因素的Logistic回归分析[J].南京医科大学学报:自然科学版,2015,35(7):1022-1025.
[16] Coalson JJ.Pathology of bronchopulmonary dysplasia[J].Semin Perinatol, 2006, 30(4): 179-184.
[17] Martin RJ,Fanaroff AA.The preterm lung and airway: past, present, and future[J].Pediatr Neonatol,2013,54(4):228-234.
[18] 中华医学会儿科学分会呼吸学组肺功能协作组《中华实用儿科临床杂志》编辑委员会.儿童肺功能系列指南(四):潮气呼吸肺功能[J].中华实用儿科临床杂志,2016,31(21):1617-1621.
[19] Verheggen M, Willson AC, Pillow JJ, et al.Respiratory function and symptoms in young preterm children in the contemporary era[J].Pediatr Pulmonol, 2016, 51(12):1347-1355.
[20] Beydon N,Davis SD,Lombardi E,et al.An official American Thoracic Society/European Respiratory Society statement:pulmonary function testing in preschool children[J].Am J Respir Crit Care Med,2007,175(12):1304-1345.
[21] 刘敬,黄俊谨,陈颖,等.肺脏超声对早产儿长期氧依赖肺部原因的鉴别价值[J].中国小儿急救医学,2014,21(12):786-789.
PDF(608 KB)
