重度支气管肺发育不良患儿内源性呼气末正压测定及其临床结局

Measurement of intrinsic positive end-expiratory pressure and clinical outcomes of infants with severe bronchopulmonary dysplasia

摘要:

目的 探讨重度支气管肺发育不良（severe bronchopulmonary dysplasia, sBPD）患儿内源性呼气末正压（intrinsic positive end-expiratory pressure, PEEPi）水平及不同水平PEEPi与临床结局的关系。方法 回顾性分析2022年1月—2023年6月在广州市妇女儿童医疗中心住院的12例接受过PEEPi测量的sBPD患儿的临床资料，并比较极高PEEPi（≥10 cmH₂O）与较低PEEPi（<10 cmH₂O）sBPD患儿的临床表现及临床结局。结果 12例sBPD患儿在纠正胎龄31⁺³~67⁺²周之间进行PEEPi测量，最低为0.9 cmH₂O，最高为19.6 cmH₂O，其中50%（6/12）患儿PEEPi≥10 cmH₂O。所有极高PEEPi患儿临床均存在无效触发和人机不协调现象，5例患儿无法脱离有创通气，其中4例死亡、1例气管切开带机出院。而PEEPi<10 cmH₂O患儿仅1例死亡，其余均拔管好转出院。结论 sBPD患儿可能存在高PEEPi，高PEEPi可能与sBPD患儿的不良结局有关。

Abstract:

Objective To investigate the levels of intrinsic positive end-expiratory pressure (PEEPi) in infants with severe bronchopulmonary dysplasia (sBPD) and the relationship between different levels of PEEPi and clinical outcomes.Methods A retrospective analysis was conducted on the clinical data of 12 sBPD infants who underwent PEEPi measurement and were hospitalized at Guangzhou Women and Children's Medical Center from January 2022 to June 2023. The clinical manifestations and outcomes at discharge were compared between infants with very high PEEPi (≥10 cmH₂O) and those with lower PEEPi (<10 cmH₂O).Results PEEPi measurements were taken in 12 sBPD infants between gestational age 31⁺³ and 67⁺² weeks postmenstrual age, with the lowest PEEPi measured at 0.9 cmH₂O and the highest at 19.6 cmH₂O; 50% (6/12) of the infants had PEEPi ≥10 cmH₂O. All infants with very high PEEPi exhibited ineffective triggering and patient-ventilator asynchrony. Among them, 5 infants could not be weaned off invasive ventilation, resulting in 4 deaths and 1 infant being discharged with a tracheostomy and ventilator support. In contrast, among the infants with PEEPi <10 cmH₂O, only 1 infant died, while the others were successfully extubated and discharged.Conclusions Infants with sBPD may have elevated PEEPi levels, and very high PEEPi may be associated with adverse outcomes in these patients.