新生儿机械通气后远期肺功能随访

目的　了解新生儿机械通气对远期肺功能及反复呼吸道疾病影响。方法　新生儿期用呼吸机治疗16例患儿 ,8年后对其进行随访 ,并作肺功能检测。结果　 5 0 %患儿有反复呼吸道疾病症状 ,75 %患儿肺功能异常 ,其中残气量 /肺总量 (RV/TLC)为 5 6 .2 5 %、肺活量 2 5 %时最大呼气流量 (Vmax 2 5 )为 4 3.7%、特殊呼吸道阻力 (sRaw)及特殊呼吸道传导 (sGaw)均为 5 0 %。吸气峰压 (PIP) >2 5cmH2 O组用力肺活量中期平均呼气流速 (FEF 2 5 %～ 75 % )及 5 0 %用力肺活量时的最大呼气流速 (Vmax 5 0 )低于PIP <2 5cmH2 O组。呼气末正压 (PEEP)≤ 4cmH2 O组sRaw >4cmH2 O组。结论　新生儿机械通气可影响远期肺功能。较高PIP或过低PEEP可引起肺损伤 ,从而引起呼吸道阻力增加 ,呼吸道高反应。而儿童期反复呼吸道疾病可能与肺损伤后支气管反应性增高有关

Long-term pulmonary function follow-up treated by neonatal mechanical ventilation

Objective To investigate the effect of neonatal mechanical ventilation on lung function and recurrent respiratory diseases of patients.Methods Lung function and recurrent respiratory diseases were studied in 16 children who had been ventilated at birth and were followed up in 8 years later.Results Fifty percentage of them had recurrent respiratory diseases and 75 % of had lung function abnormalities, in which residual volume/ total lung capacity (RV/ TLC) was 56.25 %,43.7 % (Vmax 25),specific airway resistance (sRaw) and specific airway conductance (sGaw) 50 % respectively. The forced expiratory flow during 25 %-75 % of forced vital capacity (FEF 25 %-75 %) and maximal expiratory flow rate at 50 % FVC (Vmax50) in the high peak respiratory pressure (PIP) group were lower than those in low PIP group (P<0.05). The sRaw in low positive end-expiratory pressure (PEEP) group was higher than that in high PEEP group (P<0.05).Conclusions Mechanical ventilation in neonatal period has a long effect on lung function. The high PIP and very low PEEP are able to result in pulmonary injury and airway hyperresponsiveness. The recurrent respiratory diseases in these children may be associated with increased airway responsiveness followed-up by lung injury.