HYPOCAPNIA BEFORE SURFACTANT THERAPY APPEARS TO INCREASE BRONCHOPULMONARY DYSPLASIA RISK IN INFANTS WITH RESPIRATORY-DISTRESS SYNDROME
HYPOCAPNIA BEFORE SURFACTANT THERAPY APPEARS TO INCREASE BRONCHOPULMONARY DYSPLASIA RISK IN INFANTS WITH RESPIRATORY-DISTRESS SYNDROME
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DOI：
10.1001/archpedi.1995.02170190027005
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发表时间：
1995-06-01
影响因子：
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通讯作者：
LEVITON, A
中科院分区：
文献类型：
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作者：
GARLAND, JS;BUCK, RK;LEVITON, A
目的：确定首次使用人工表面活性剂抢救前通气管理对支气管肺发育不良风险的影响程度。研究设计：回顾性队列研究。受试者：188 名低出生体重婴儿（小于或等于 1700 g），因呼吸窘迫综合征接受人工表面活性剂治疗，并在 36 周胎龄时存活。结果：支气管肺发育不良的定义孕龄 36 周时需要补充氧气以维持 92% 或更高的动脉饱和度。结果：该队列中 37% (70/188) 的人符合支气管肺发育不良的研究标准。在最简约的后向逐步 Logistic 回归模型中，与支气管肺发育不良显着相关的早期决定因素（以比值比，95% 置信区间给出）包括：出生体重 1000 g 或更低（5.1、2.4 至 10.7）、因胎儿窘迫而剖腹产（4.4、1.7 至 11.4）、使用表面活性剂前通气效率指数为 0.15 或更低治疗前（3.1，1.4至6.8），表面活性剂治疗前动脉肺泡氧比为0.15或更低（2.2，1.01至4.6），以及低动脉PCO2（小于或等于29与大于或等于40毫米汞柱，5.6，2.0至15.6；30至39与大于或等于40毫米汞柱，3.3、1.3 至 8.3）。即使在分层分析中，低碳酸血症与支气管肺发育不良之间的反比关系仍然存在，这些分析仅限于对心血管或呼吸系统疾病进行测量的婴儿，这些疾病表明疾病表现较不严重。 结论：在导致低碳酸血症的人工表面活性剂治疗抢救治疗之前进行通气管理可能会增加支气管肺发育不良的风险。这些研究结果表明，早期通气管理不仅应提供足够的氧合，还应限制过度通气。
Objective: To determine to what extent the risk of bronchopulmonary dysplasia is affected by ventilatory management before the first dose of rescue artificial surfactant.Study Design: Retrospective cohort study.Subjects: One hundred eighty-eight low-birth-weight infants (less than or equal to 1700 g) who received artificial surfactant therapy for respiratory distress syndrome and who were alive at 36 weeks of gestational age.Outcome: Bronchopulmonary dysplasia was defined by a need for supplemental oxygen to maintain an arterial saturation of 92% or more at 36 weeks of gestational age.Results: Thirty-seven percent (70/188) of the cohort met study criteria for bronchopulmonary dysplasia. Early determinants significantly associated with bronchopulmonary dysplasia (given as odds ratio, 95% confidence interval) in the most parsimonious backward stepwise logistic regression model included the following: birth weight of 1000 g or less (5.1, 2.4 to 10.7), cesarean birth because of fetal distress (4.4, 1.7 to 11.4),ventilatory efficiency index of 0.15 or less before surfactant therapy (3.1, 1.4 to 6.8), arterial-alveolar oxygen ratio of 0.15 or less before surfactant therapy (2.2, 1.01 to 4.6), and a low arterial PCO2 (less than or equal to 29 vs greater than or equal to 40 mm Hg, 5.6, 2.0 to 15.6; 30 to 39 vs greater than or equal to 40 mm Hg, 3.3, 1.3 to 8.3). The inverse relationship between hypocarbia and bronchopulmonary dysplasia persisted even in stratified analyses limited to infants with measures of cardiovascular or respiratory illness that suggested less severe manifestations of disease.Conclusions: Ventilatory management before rescue treatment with artificial surfactant therapy that result in hypocarbia may increase the risk of bronchopulmonary dysplasia. These findings suggest that early ventilatory management should not only provide adequate oxygenation but also limit hyperventilation.