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[NEJM最新论文]:极早产儿机械通气不改善患儿远期呼吸功能
2017年07月29日 时讯速递, 进展交流 暂无评论

ORIGINAL ARTICLE

Ventilation in Extremely Preterm Infants and Respiratory Function at 8 Years

Lex W. Doyle, M.D., Elizabeth Carse, M.D., Anne-Marie Adams, Ph.D., Sarath Ranganathan, Ph.D., Gillian Opie, M.B., B.S., and Jeanie L.Y. Cheong, M.D., for the Victorian Infant Collaborative Study Group*

N Engl J Med 2017; 377:329-337 July 27, 2017

DOI: 10.1056/NEJMoa1700827

BACKGROUND 背景

Assisted ventilation for extremely preterm infants (<28 weeks of gestation) has become less invasive, but it is unclear whether such developments in care are associated with improvements in short-term or long-term lung function. We compared changes over time in the use of assisted ventilation and oxygen therapy during the newborn period and in lung function at 8 years of age in children whose birth was extremely premature.

极早产儿(孕周< 28周)辅助通气越来越多采用无创模式,但尚不清楚这一改变是否伴随近期或远期肺功能改善。我们比较了极早产儿在新生儿期间辅助通气及氧疗的使用随时间的变化,及其与8岁时肺功能的相关性。

METHODS 方法

We conducted longitudinal follow-up of all survivors of extremely preterm birth who were born in Victoria, Australia, in three periods — the years 1991 and 1992 (225 infants), 1997 (151 infants), and 2005 (170 infants). Perinatal data were collected prospectively, including data on the duration and type of assisted ventilation provided, the duration of oxygen therapy, and oxygen requirements at 36 weeks of age. Expiratory airflow was measured at 8 years of age, and values were converted to z scores for age, height, ethnic group, and sex.

我们对澳大利亚维多利亚3个阶段(1991至1992年[225名婴儿],1997年[151名婴儿]及2005年[170名婴儿])内出生的存活的极早产儿进行了纵向随访研究。前瞻收集围产期资料,包括辅助通气持续时间及种类,氧疗持续时间,以及36周时对氧疗的需求。在患儿8岁时测定呼气流量,并根据年龄、身高、种族和性别转变为Z评分。

RESULTS 结果

The duration of assisted ventilation rose substantially over time, with a large increase in the duration of nasal continuous positive airway pressure. Despite the increase in the use of less invasive ventilation over time, the duration of oxygen therapy and the rate of oxygen dependence at 36 weeks rose, and airflows at 8 years of age were worse in 2005 than in earlier periods. For instance, for 2005 versus 1991–1992, the mean difference in the z scores for the ratio of forced expiratory volume in 1 second to forced vital capacity was −0.75 (95% confidence interval [CI], −1.07 to −0.44; P<0.001), and for 2005 versus 1997 the mean difference was −0.53 (95% CI, −0.86 to −0.19; P=0.002).

随时间推移,辅助通气持续时间显著增加,主要为经鼻持续气道正压通气持续时间延长。尽管创伤较小通气方式的使用随时间推移明显增加,且36周时依赖氧疗的比例增加,但2005年组患儿8岁时呼气流量显著恶化。例如,与1991-1992年组相比,2005年组一秒率的Z评分平均差异为−0.75 (95% 可信区间 [CI], −1.07 to −0.44; P<0.001),2005年组与1997年组相比,平均差异为−0.53 (95% CI, −0.86 to −0.19; P=0.002)。

CONCLUSIONS 结论

Despite substantial increases in the use of less invasive ventilation after birth, there was no significant decline in oxygen dependence at 36 weeks and no significant improvement in lung function in childhood over time. (Funded by the National Health and Medical Research Council of Australia and the Victorian Government’s Operational Infrastructure Support Program.)

尽管出生后使用创伤较小通气方式显著增加,但36周时依赖氧疗的比例无显著降低,儿童阶段肺功能也没有显著改善。

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