| Now,with the development of medicine,including the application of pulmonary surfactant,the use of prenatal steroids,lung protective mechanical ventilation strategy and the use of non-invasive ventilator,the survival rate of premature infants increased year by year,but the quality of life after the survival of premature infants has attracted much attention.Premature infants with immature lung development and insufficient pulmonary surfactant are often associated with various respiratory diseases after birth,and even need asphyxia recovery,mechanical ventilation,and a long hospital stay.Neonatal respiratory distress syndrome and Bronchopulmonary dysplasia are common respiratory diseases in premature infants.In clinical work,it has been found that preterm infants who survive have a higher frequency of respiratory diseases in infancy,and lung function test can be used as a means to evaluate the respiratory function of children.Infants detection methods include tidal breathing analysis,Xiong Fu Qiang extrusion method,blocking method,plethysmography,sulfur-hexafluoride function measurement residual gas and imaging techniques,tidal breathing analysis is one of the respiration signal captured by the flow sensor check method,the test result can reflect the entire respiratory system function change,this method is simple,safe,and does not need children to special cooperate,the detection method has been carried out in our country for more than 20 years,as the main method of neonatal pulmonary function examination now.At present,there are more and more studies on neonatal lung function and follow-up at home and abroad,but there are few studies on the influencing factors of lung function.PurposeBy follow-up of the preterm infants treated in our hospital at the corrected gestational age of 40 weeks,1.To analysis the risk factors affecting lung function;2.To compare the difference of lung function index between premature infants of different gestational age and control group;3.To compare the pulmonary function of neonates with and without neonatal respiratory distress syndrome(NRDS).To understand the risk factors affecting lung function,in order to improve clinicians’ understanding of lung function of premature infants,and to provide reference and guidance for future maternal health care,treatment during pregnancy and postnatal treatment of neonates.Materials and methods1.Subjects(1)This study selected 85 premature infants admitted to the neonatal intensive care unit of Liaocheng people’s hospital from January to October,2018,who were followed up at 40 weeks of corrected gestational age to the outpatient department of pediatrics and tested for moisture respiratory and pulmonary functions,including 46 males and 39 females.(2)Twenty-three full-term newborns hospitalized for non-respiratory diseases in the same period were selected as the control group,including 11 males and 12 females,with gestational age of 38-40 weeks,and lung function detection time of 2-4 days after hospitalization.(3)Exclusion criteria: Concomitant congenital malformations and congenital diseases affecting lung function;The subjects were complicated with respiratory diseases;The mother had a history of smoking;Patients with asthma in first-degree relatives;The subjects were treated with drugs that affected lung function.Group: according to gestational age,premature infants are divided into early premature infants group(P1 group,gestational age <32 weeks,n=32),intermediate premature infants group(P2 group,32 weeks ≤gestational age <34 weeks,n=25),and advanced premature infants group(P3 group,gestational age ≥34 weeks,n=28).2.Methods(1)In this study,the lung function instrument produced by Germany kangxun company was used for detection.In drug(10% chloral hydrate)under sedation,all children are taking the supine position,select the appropriate mask fasten on the patient’s mouth and nose,guarantee not leak,velocity and capacity of the signal through the velocity sensor measurements show that,on the computer record 5 times in a row,after smooth breathing every time record at least 20 moisture flow-volume ring breathing,instrument take its average as the final result,storage,printing reports.The gestational age,sex,body length and weight of the newborn were recorded routinely before examination.Basic information,perinatal status,postnatal treatment status and specific indicators of lung function were recorded in detail in the follow-up table of the experimental group and the control group.(2)Retrospective analysis of clinical data of premature infants during hospitalization,through statistical methods to analyze the effects of 15 indicators gender on lung function.These indicators are gestational age(GA),birth weight(BW),whether more tyres,prenatal whether combination of premature rupture of membranes,1 min Apgar score(Apgar1),5 minutes Apgar score(Apgar5),whether the merger of neonatal respiratory distress syndrome(NRDS),bronchial pulmonary dysplasia(BPD),Patent ductus arteriosus(PDA),Extra uterine growth retardation(EUGR),the usage of caffeine,the usage of hormone,the time up to full enteral feeding,anemia at discharge.Results1.Analysis results of influencing factors of lung functionSingle factor analysis results show: gestational age,birth weight,and 1 minute Apgar score,5 minute Apgar score,premature rupture of membranes,bronchopulmonary dysplasia(BPD),Patent ductus arteriosus(PDA),neonatal respiratory distress syndrome(RDS),the time to reach full enteral feeding,anemia,extra uterine growth retardation(EUGR)has obvious correlation with pulmonary function outcome(P < 0.05).Multivariate Logistic regression analysis showed that premature rupture of membranes,PDA and EUGR were independent risk factors for pulmonary dysfunction.Gestational age,caffeine use,and postpartum hormone use were independent protective factors for lung function.2.The results of the comparition of the lung function of each groupThe results of anova showed statistically significant differences in mean time to peak tidal expiratory flow(Tptef Mean),mean volume to peak tidal expiratory flow(Vptef Mean),ratio of Tptef and total Te(Tptef/Te),ratio of Vptef and total Ve(Vptef/Ve),tidal volume(VT),tidal expiratory flow at 50% lung volume(TEF50),tidal expiratory flow at 25%lung volume(TEF25),and minute ventilation(MV)between the four groups.Further pairto-pair comparison showed that Tptef/Te,Vptef/Ve,TEF50,TEF25,Tptef Mean,Vptef Mean and MV in P1 group were lower than those in full-term infant control group at40 weeks of corrected gestational age,and the difference was statistically significant(P<0.05).Tptef/Te,Vptef/Ve,VT,TEF25,Tptef Mean and Vptef Mean in P2 group were all lower than those in full-term control group,and the difference was statistically significant(P<0.05).Tptef/Te,Vptef/Ve,Tptef Mean and Vptef Mean in the P3 group were lower than those in the full-term control group,and the differences were statistically significant(P<0.05),while the differences in other lung function indicators were not statistically significant.TEF50,TEF25,Vptef Mean and MV in group P1 were lower than those in group P3,and the difference was statistically significant(P<0.05).VT in group P2 was lower than that in group P3,and the difference was statistically significant(P<0.05),while the difference in other pulmonary function indicators was not statistically significant.There was no significant difference in pulmonary function indexes between P1 group and P2 group.3.The differents of the lung function parameters between the RDS group and the non-RDS group at 40 weeks of corrected gestational ageTptef/Te of premature infants in the RDS group was significantly lower than that in the non-RDS group(P<0.05),and the differences in other indicators were not statistically significant.Conclusion1.Premature rupture of membranes,patent ductus arteriosus and Extra uterine growth retardation are independent risk factors for abnormal lung function.Therefore,it is necessary to strengthen prenatal health care,avoid premature delivery,strengthen respiratory and circulatory management,and ensure a good nutritional status to reduce the occurrence of abnormal lung function.2.The corrected gestational age of premature infants to 40 weeks still showed obstructive ventilation dysfunction,and the level of lung function still could not reach the level of normal full-term infants.The younger the gestational age,the more obvious the performance.3.After the treatment of premature infants with RDS,the problerm of small airway obstruction has been improved to a certain extent by the time the corrected gestational age reaches full term. |
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