剖宫产儿早期潮气呼吸肺功能的研究

Early tidal breathing lung function in neonates delivered by caesarean section

摘要:

目的：研究剖宫产儿早期潮气呼吸肺功能各项指标的特点。探讨剖宫产对新生儿早期肺功能的影响。方法：研究对象分两组:剖宫产组42例,阴道分娩组33例;采用潮气呼吸法测定两组新生儿1h内潮气呼吸肺功能的各项指标。主要参数: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%,75%潮气量时呼气流速(TEF25%,TEF50%,TEF75%)。同时描绘出流速容量环(TFVcurve)。结果：剖宫产组MV为1.16±0.31L/min,VT/kg4.81±1.05mL/kg较阴道分娩组1.34±0.33L/min,5.55±1.24mL/kg明显缩小(P<0.05)。PTEF为69.40±21.96mL/s,TEF25%为62.17±20.62mL/s较阴道分娩儿59.03±15.23mL/s,51.52±13.83mL/s明显增快(P<0.05)。反映气道阻塞的指标:TPEF/TE和VPEF/VE分别为(66.08±11.51)%和(62.19±8.69)%高于经阴道分娩组(60.36±9.70)%和(55.75±7.28)%(P<0.05)。而RR,TI,TE,TI/TE,TEF50%,TEF75%两组无显著差异(P>0.05)。流速容量环:两组新生儿流速容量环呈较狭长的不规则椭圆型,呼气流速峰值延迟出现,剖宫产组的流速容量环窄于经阴道分娩儿,呼气流速峰值高于阴道分娩组。结论：剖宫产儿1h内潮气呼吸肺功能显示潮气量、每分通气量小于经阴道分娩儿,剖宫产儿较阴道分娩儿在1h内限制性通气功能障碍更明显,大气道的阻塞亦更明显。

Abstract:

OBJECTIVE: The!aim of this study was to investigate the influence of caesarean section on early pulmonary function of the neonate by examining the tidal breathing parameters in neonates delivered by caesarean section and comparing them with the parameters of neonates delivered vaginally. METHODS: The subjects included 42 neonates delivered by caesarean section and 30 neonates delivered vaginally. Various pulmonary function parameters were assayed by the tidal breathing method within 1 hr after birth. The parameters included minute ventilation (MV), respiratory rate (RR), tidal volume (VT), inspiratory time (TI), expiratory time (TE), ratio Ti/Te (TI/TE), peak tidal expiratory flow (PTEF), time to PTEF (TPEF), ratio of TPEF and total TE (TPEF/TE), expiratory volume at PTEF (VPEF), ratio of VPEF and total VE (VPEF/VE), and TEF25%, TEF50% and TEF75% remaining (TEF25%, TEF50%, TEF75%). Tidal flow-volume (TFV) curves were also constructed. RESULTS: MV (1.16±0.31 L/min) and VT(4.81±1.05 mL/kg) in neonates delivered by caesarean section were remarkably lower than in those delivered vaginally (1.34±0.33 L/min and 5.55±1.24 mL/kg, respectively; P<0.05). The neonates delivered by caesarean section showed faster PTEF (69.40±21.96 mL/s vs 59.03±15.23 mL/s; P<0.05) and TEF25% (62.17±20.62 mL/s vs 51.52±13.83 mL/s; P< 0.05) compared with those delivered vaginally. TPEF/TE (66.08%±11.51%) and VPEF/VE (62.19%±8.69 %) in neonates delivered by caesarean section were significantly higher than in those delivered vaginally(60.36%±9.70% and 55.75%±7.28%, respectively; P<0.05). No statistical differences were found between the two groups for RR, TT, TE, TI/TE, TEF50% and TEF75%. TFV curves of both groups presented with slender and irregular ellipse in shape and peak value in expiratory flow appeared late . In neonates delivered by caesarean section, the TFV curve was narrower and peak value in expiratory flow was higher than in those delivered vaginally. CONCLUSIONS: VT and MV were lower and restrictive hypoventilation was more severe within 1 hr after birth in neonates delivered by caesarean section compared with those delivered vaginally.