剖宫产儿潮气呼吸肺功能的动态变化

目的 观察剖宫产儿潮气呼吸肺功能各项指标的动态变化。研究剖宫产儿与阴道分娩儿肺功能的差异。为足月新生儿早期肺功能提供参考数值。方法 研究对象：剖宫产儿144例，阴道分娩儿116例；采用潮气呼吸法测定两组新生儿出生后第1小时内、第12—24小时内（第1天）、第3天、第5天的潮气呼吸肺功能的各项指标。主要参数为：每分通气量（MV），呼吸频率（RR），潮气量（VT／kg），吸气时间（TI），呼气时间（TE），吸呼比（TI/TE），达峰时间（TPEF），达峰时间比（TPEF／TE），达峰容积（VPEF），达峰容积比（VPEF／VE），潮气呼吸呼气峰流速（PTEF），25％，50％或75％潮气量时呼气流速（TEF25％，TEF50％，TEF75％）。结果 在1h内剖宫产组潮气量较自然分娩组小，每分通气量较小（P〈0．05），达峰时间比和达峰客积比高于阴道分娩组（P〈0．05），而呼吸频率、吸呼比、达峰时间两组差异无统计学意义（P〉0．05）。在1、3、5d剖宫产组较自然分娩组各潮气呼吸肺功能指标比较，差异均无统计学意义（P〉0．05）。剖宫产组中：第1h组呼吸频率较第1天组增快，潮气量较第1天组缩小，而每分通气量较第1天组增大。而吸呼比、达峰时间、两组差异无统计学意义（P〉0.05）。第1天组与第3天组、第3天组与第5天组各潮气呼吸肺功能指标比较，差异均无统计学意义（P〉0．05）。结论 剖宫产儿1h内存在较阴道分娩儿更明显的限制性通气功能障碍、大气道的阻塞。这一改变在12h内可以自限。潮气呼吸肺功能可作为新生儿呼吸监护重要的无创手段。     

剖宫产儿潮气呼吸肺功能的动态变化

目的观察剖宫产儿潮气呼吸肺功能各项指标的动态变化。研究剖宫产儿与阴道分娩儿肺功能的差异。为足月新生儿早期肺功能提供参考数值。方法研究对象:剖宫产儿144例,阴道分娩儿116例;采用潮气呼吸法测定两组新生儿出生后第1小时内、第1224小时内(第1天)、第3天、第5天的潮气呼吸肺功能的各项指标。主要参数为:每分通气量(MV),呼吸频率(RR),潮气量(VT/kg),吸气时间(TI),呼气时间(TE),吸呼比(TI/TE),达峰时间(TPEF),达峰时间比(TPEF/TE),达峰容积(VPEF),达峰容积比(VPEF/VE),潮气呼吸呼气峰流速(PTEF),25%,50%或75%潮气量时呼气流速(TEF25%,TEF50%,TEF75%)。结果在1h内剖宫产组潮气量较自然分娩组小,每分通气量较小(P<0·05),达峰时间比和达峰容积比高于阴道分娩组(P<0·05),而呼吸频率、吸呼比、达峰时间两组差异无统计学意义(P>0·05)。在1、3、5d剖宫产组较自然分娩组各潮气呼吸肺功能指标比较,差异均无统计学意义(P>0·05)。剖宫产组中:第1h组呼吸频率较第1天组增快,潮气量较第1天组缩小,而每分通气量较第1天组增大。而吸呼比、达峰时间、两组差异无统计学意义(P>0·05)。第1天组与第3天组、第3天组与第5天组各潮气呼吸肺功能指标比较,差异均无统计学意义(P>0·05)。结论剖宫产儿1h内存在较阴道分娩儿更明显的限制性通气功能障碍、大气道的阻塞。这一改变在12h内可以自限。潮气呼吸肺功能可作为新生儿呼吸监护重要的无创手段。     

婴幼儿潮气呼吸肺功能临床应用进展

潮气呼吸肺功能检测经由流量传感器获得潮气流量、容积信号,可用于评价潮气呼吸状态肺功能,虽然受部分因素干扰,但因其具有高敏感性、高安全性、无需儿童主动配合且易操作等明显优势,所以临床广泛应用于婴幼儿,包括婴幼儿喘息、新生儿支气管肺发育不良等疾病的临床诊断与鉴别诊断、预后评价等方面。该文对国内外潮气呼吸肺功能在婴幼儿中的应...     

呼吸窘迫综合征新生儿治疗后潮气呼吸肺功能检测

目的探讨不同胎龄以及不同程度的呼吸窘迫综合征(RDS)新生儿经治疗后肺功能的情况。方法 107例RDS新生儿分为小于34周早产儿组(65例),晚期早产儿组(21例)及足月儿组(21例),同时选取121例非RDS患儿作为对照组。根据RDS程度将RDS新生儿分为轻度RDS(1、2级)及重度RDS(3、4级)。于纠正胎龄44周时行潮气呼吸肺功能测定。结果不同胎龄RDS新生儿的肺功能参数未见明显差异;RDS组的达峰时间比(TPEF/t E)、达峰容积比(VPEF/VE)较同胎龄对照组小(P0.05);两组不同程度RDS新生儿于纠正胎龄44周时TPEF/t E、VPEF/VE也低于对照组(P0.05),且随着RDS程度加重,其值呈下降趋势。结论 RDS新生儿纠正胎龄44周时肺功能水平明显低于非RDS新生儿;RDS新生儿纠正胎龄44周时潮气呼吸肺功能水平与胎龄无关,主要与RDS严重程度有关。     

极低出生体重儿支气管肺发育不良潮气呼吸肺功能临床观察

目的 研究极低出生体重儿支气管肺发育不良(bronchopulmonary dysplasi,BPD)潮气呼吸肺功能的改变.方法 选取在温州市儿童医院住院的262例极低出生体重儿作为研究对象,在出院前1周内和纠正胎龄6~8个月时做潮气呼吸肺功能检测.根据临床诊断,分为BPD组(65例)和非BPD组(197例),BPD组根据严重程度分为轻度BPD组(31例)、中度BPD组(20例)和重度BPD组(14例),比较不同组患儿的肺功能指标.结果 出院前1周内测量潮气呼吸肺功能显示,BPD组患儿呼吸频率较非BPD组均增快(P均＜0.05);呼气峰流速,75%、50%、25%潮气量时的呼气流速比较,均为重度BPD组高于其余组(P均＜0.05),轻度BPD组低于非BPD组(P均＜0.05);达峰时间比、达峰容积比BPD组较非BPD组均降低,BPD程度越严重,下降越明显(P均＜0.05);各组间潮气量比较差异无统计学意义(P＞0.05).矫正胎龄6~8个月时行潮气呼吸肺功能检查,呼气峰流速,75%、50%、25%潮气量时的呼气流速比较,提示重度BPD组仍较其余组均高(P均＜0.05),达峰时间比、达峰容积比仍低于其余组(P均＜0.05),而其余各组间比较各指标差异均无统计学意义(P＞0.05).结论 出院前1周内BPD患儿有不同程度的肺功能损伤,但随日龄增大(矫正胎龄6~8个月时),部分肺功能指标逐渐改善,但早期重度小气道阻塞性病变仍较严重,因此,积极预防、治疗BPD对呼吸道疾病的防治有重要意义.     

气管支气管软化患儿潮气呼吸肺功能特征的研究

目的探讨气管支气管软化(TBM)患儿潮气呼吸肺功能的特征,为TBM患儿的诊断、疗效评估、预后判断提供新的思路。方法选取30例经电子支气管镜诊断为TBM的患儿作为研究组,30例健康儿童作为正常对照组。正常对照组和TBM组初诊时以及确诊后3个月、6个月、9个月、12个月进行潮气呼吸肺功能测定。结果 TBM确诊时与对照组在潮气量及吸气时间、呼气时间、吸呼比的差异无统计学意义(P0.05);与对照组比,TBM组确诊时的呼吸频率较快,达峰时间比和达峰容积比较低,差异具有统计学意义(P0.01);TBM患儿初诊时及确诊后3、6、9、12个月的潮气呼吸肺功能达峰时间比、达峰容积比逐渐增大。结论 TBM患儿潮气呼吸肺功能具有特征性改变,而且随着年龄增大,潮气呼吸肺功能逐渐接近正常。     

潮气呼吸肺功能临床应用中需注意的问题

潮气呼吸肺功能检测是最常用的婴幼儿肺功能检测方法,因为其无创、操作简便、无需患儿配合等优点而被儿科医师及家长广泛接受.潮气呼吸肺功能检测应用时间短、专业性强,广大儿科医务人员对其操作质量控制和报告解读的能力仍有待提高.现就潮气呼吸肺功能在检测过程、报告解读以及药物试验结果分析中需要注意的几个问题进行阐述.     

婴幼儿肺炎治疗前后潮气呼吸肺功能指标的变化

目的：探讨婴幼儿肺炎治疗前后肺功能的变化。方法：采用潮气呼吸法测定58名1～40个月的肺炎婴幼儿流速 容量环(TFV)。以63名同龄健康儿童做对照。主要参数为：达峰时间(TPTEF),达峰时间比(TPTEF/TE),达峰容积(VPEF),达峰容积比(VPEF/VE),吸呼比(TI/TE),呼气峰流速(PEF),25%,50%或75%潮气量时的呼气流速(TEF 25%,TEF 50%,TEF 75%)。同时描绘出流速-容量环。结果：流速-容量环在健康儿童呈椭圆型,在肺炎治疗前呼气降支的斜率较健康儿童大,阻塞越重,斜率越大,甚至向内凹陷。肺炎治疗前患儿呼吸频率(RR)为(36±9)次/分,较同龄对照(30±8)次/分明显增快(P<0.01),吸气和呼气时间均缩短,但以前者更明显,吸呼比(TI/TE)降低。肺炎治疗前TPTEF(0.20±0.08) S和VPEF(17.2±10.9) ml也明显低于健康组［(0.40±0.16) S,(25.4±12.8) ml］。反映气道阻塞的指标：TPTEF/TE和VPEF/VE分别为(18.8±5.8)%和(22.1±4.6)%低于健康对照组［(33.0±7.54)%,(33.4±6.35)%］(P<0.01)。经治疗后,患儿呼吸频率逐渐下降为(33±11)次/分,TPTEF和VPEF均明显回升,TPTEF/TE,VPEF/VE显著增高为(26.2±8.7)%和(28.4±7.3)%(P<0.01),但仍低于健康儿童相应指标。结论：潮气呼吸测定能反映肺炎气道病变的程度及临床治疗的效果。     

潮气呼吸肺功能在反复喘息婴幼儿中的应用及临床意义

目的探讨不同类型反复喘息婴幼儿潮气呼吸肺功能的变化及临床意义。方法选取2013年10月至2014年2月收治的3岁以下反复喘息患儿80例,根据哮喘预测指数分为阳性组和阴性组,分别在入院时(急性期)、出院时(缓解期)和出院后1周(恢复期)测定其潮气呼吸肺功能,比较两组喘息患儿的达峰时间比(TPTEF/TE)和达峰容积比(VPEF/VE);并与20例健康儿童对照比较。结果从急性期、缓解期至恢复期,阳性组和阴性组的TPTEF/TE和VPEF/VE均呈上升趋势,不同时期之间的差异均有统计学意义(P均=0.000)。急性期时,TPTEF/TE和VPEF/VE在阳性组和阴性组间的差异无统计学意义(P0.05),但均低于对照组,差异有统计学意义(P0.05);到缓解期时,阴性组的TPTEF/TE和VPEF/VE均已高于阳性组,但低于对照组,差异有统计学意义(P0.05);恢复期时,阴性组和对照组间TPTEF/TE、VPEF/VE的差异无统计学意义(P0.05),且均高于阳性组,差异有统计学意义(P0.05)。结论哮喘预测指数阳性婴幼儿的肺功能损害比哮喘预测指数阴性患儿持续时间长;运用潮气呼吸肺功能为反复喘息婴幼儿预测哮喘提供客观的临床指标。     

窒息新生儿潮气呼吸肺功能的检测

新生儿肺功能测定是反映新生儿呼吸系统疾病的病理生理变化、帮助疾病诊断及评估疾病严重程度的重要辅助检查方法.本资料采用病例对照研究方法,选取我院20例经阴道分娩出生的窒息新生儿在出生后30min内进行潮气呼吸肺功能测定,探讨窒息新生儿肺功能指标与正常新生儿的差异.     

Neutrophil chemotaxis in infants delivered by caesarean section

We evaluated polymorphonuclear leucocyte (PMN) chemotaxis and cortisol levels in cord blood from 15 healthy term infants delivered by caesarean section and from 15 healthy vaginally delivered term infants. Mean neutrophil chemotaxis was significantly higher in infants delivered by caesarean section (78.3±23.4m) than in vaginally delivered infants (57.8±16.6 m;P=0.01). Mean blood cortisol level was significantly lower in infants delivered by caesarean section (9.14±2.76 g/dl) than in infants born by vaginal delivery (20.71±6.98 g/dl;P=0.0001). No relationship was found between PMN chemotaxis and blood cortisol level. The higher neutrophil chemotactic activity observed in infants delivered by caesarean section could be related to general maternal anaesthesia.     

Neonatal blood glucose concentrations in caesarean and vaginally delivered term infants

Background: Little is known about the glucose concentrations at and after birth of infants delivered by caesarean section (CS), when compared with infants born vaginally (VD). Aim: To compare venous cord blood glucose concentrations of term infants born after elective CS to infants born by VD. We studied the null hypothesis that mode of delivery does not affect neonatal blood glucose values. Methods: We compared cord blood glucose concentrations in healthy term infants born after VD (n = 16) or by elective CS (n = 21). Glucose concentrations were obtained immediately at birth from the umbilical cord. Kruskal–Wallis was used to compare glucose concentrations and demographic variables between the groups. Results: Gestational age was 39.6 ± 0.8 weeks in VD group vs. 38.7 ± 0.9 weeks in CS group, and birthweight was 3359 ± 494 vs. 3500 ± 528 g. Cord blood glucose concentration was higher in VD (81.3 ± 16.9 mg/dL) than CS infants (70.3 ± 9.7 mg/dL, p = 0.039). The change in blood glucose concentration over the first 2‐h of life differed significantly between the two groups, being an increase in CS versus a decrease in VD infants (?3.5 ± 15.2 vs. ?15.4 ± 24.6 mg/dL, p = 0.013). Conclusions: Glucose concentrations in VD infants are higher than in infants born by elective CS without labour.     

Lower body temperatures in infants delivered by caesarean section than in vaginally delivered infants

Clinical experience suggests that infants delivered by caesarean section have difficulties maintaining normal body temperature during the first hours after birth. To test this hypothesis, body and skin temperatures were measured and compared in healthy full-term caesarean section and vaginally delivered newborn infants. The babies were studied during the first 90 min after birth. Axillary and skin temperatures were significantly higher in the vaginally delivered group than in infants delivered by caesarean section. Infants born by non-elective caesarean section were slightly warmer during the first 90 min after birth compared to infants born by elective caesarean section. There were no significant differences in temperatures between infants cared for in a cot as compared to those cared for in an incubator. An incubator creates a physical barrier between babies and parents and incubator care might cause parental anxiety. Thus the routine of putting healthy, full-term caesarean section infants in incubators can be abandoned from a thermoregulatory point of view.     

Breathing patterns in term infants delivered by caesarean section

AIM: To compare the breathing patterns of infants born by elective caesarean section to those infants delivered by caesarean section after a failed trial of labour. METHODS: Healthy term infants born by caesarean section were studied. The study group (n = 13) had no trial of labour, whereas infants in the control group (n = 13) failed a trial of labour. Polysomnographic study was performed at 36 h of age. Heart and respiratory rate, type and duration of apnoeas, arterial oxygen saturation and lower limb movements were analysed. RESULTS: Term infants born by elective caesarean section had a shorter duration of pregnancy and weighed less. Their heart rate was faster, they had more mixed apnoeas, and during quiet sleep they had more central apnoeas of longer duration. CONCLUSION: Cardiorespiratory patterns in infants delivered by elective caesarean section are different from those delivered by caesarean section after a failed trial of labour.     

选择性剖宫产儿急性呼吸窘迫综合征发病机制研究进展

新生儿急性呼吸窘迫综合征是新生儿较常见的呼吸道疾病,多见于选择性剖宫产儿,具体发病机制复杂,肺液清除延迟是其主要发病机制,同时胎粪吸入、呼吸反射建立延迟、胎龄、宫缩发动、男性患儿、围生期窒息、母亲有糖尿病或哮喘是其危险因素。     

Skin microcirculation before and after local warming in infants delivered vaginally or by caesarean section

To elucidate early postnatal changes in skin microcirculation, term newborn infants were studied at 2,6 and 24 h after vaginal delivery (VD, n = 20) or elective caesarean section (CS, n = 10). Laser Doppler technique was used to measure perfusion, rhythmical perfusion changes, i.e. vasomotion, and reactive hyperaemia of the dorsal hand, before and after local warming of the skin to 37°C. The skin perfusion and the magnitude of reactive hyperaemia (mean 85%) remained essentially unchanged, while vasomotion increased from 0–5 to 2–8 cycles/min ( p < 0.001) during the first day of life. Local warming of the skin promoted microcirculation slightly at 2 h and more markedly at 24 h postnatal age. The CS group showed a higher degree of skin perfusion, vasomotion and reactive hyperaemia than did VD infants at 2 h postnatal age. Our findings most likely reflect skin microcirculatory effects of birth-related events, such as a drop in body temperature, sympathoadrenal activation and placental transfusion.