背景:产前炎症,通常与绒毛膜羊膜炎有关,是早产的主要原因。因为炎症会抑制呼吸驱动力,我们研究了临床绒毛膜羊膜炎(CCA)对早产儿出生时自主呼吸的影响.
方法:根据胎龄(±6天)将出生<30周的CCA婴儿与对照婴儿相匹配,出生体重(±300克),产前皮质类固醇,性和全身麻醉。主要结果是呼吸努力,评估为自主呼吸的分钟体积(MV)。我们还测量了潮气量(Vt),开始呼吸支持后的前5分钟内的呼吸频率(RR)和呼吸暂停以及前10分钟内的其他生理参数。
结果:纳入92例婴儿(n=46例CCA婴儿vs.n=46例对照;中位(IQR)胎龄26+4(25+0-27+6)vs26+6(25+1-28+3)周)。MV和Vt显着降低(MV:43(17-93)vs70(31-119)mL/kg/min,p=0.043;Vt:2.6(1.9-3.6)对2.9(2.2-4.8)mL/kg/呼吸,p=0.046),而与对照组相比,CCA婴儿的RR相似。呼吸暂停的发生率较高(5(2-6)比2(1-4),p=0.002),呼吸暂停的总持续时间更长(90(21-139)vs35(12-98)s,p=0.025)在CCA婴儿中。CCA婴儿需要更长的时间才能达到氧饱和度>80%(3:37(2:10-4:29)vs2:25(1:06-3:52)分钟,p=0.016),并且在5分钟时氧饱和度较低(77(66-92)对91(68-94)%,p=0.028),尽管接受了更多的氧气(62(48-76)对54(43-73)%,p=0.036)。
结论:CCA与早产儿出生时呼吸用力和氧合减少有关。
BACKGROUND: Antenatal inflammation, usually associated with chorioamnionitis, is a major cause of premature birth. As inflammation could depress respiratory drive, we have examined the effect of clinical chorioamnionitis (CCA) on spontaneous breathing in premature infants at birth.
METHODS: Infants with CCA born <30 weeks\' gestation were matched with control infants based on gestational age (±6 days), birth weight (±300 g), antenatal corticosteroids, sex and general anaesthesia. The primary outcome was breathing effort, assessed as minute volume (MV) of spontaneous breathing. We also measured tidal volume (Vt), respiratory rate (RR) and apnoea in the first 5 min and additional physiological parameters in the first 10 min after start of respiratory support.
RESULTS: Ninety-two infants were included (n=46 CCA infants vs n=46 controls; median (IQR) gestational age 26+4 (25+0-27+6) vs 26+6 (25+1-28+3) weeks). MV and Vt were significantly lower (MV: 43 (17-93) vs 70 (31-119) mL/kg/min, p=0.043; Vt: 2.6 (1.9-3.6) vs 2.9 (2.2-4.8) mL/kg/breath, p=0.046), whereas RR was similar in CCA infants compared with controls. Incidence of apnoea was higher (5 (2-6) vs 2 (1-4), p=0.002), and total duration of apnoea was longer (90 (21-139) vs 35 (12-98) s, p=0.025) in CCA infants. CCA infants took significantly longer to reach an oxygen saturation >80% (3:37 (2:10-4:29) vs 2:25 (1:06-3:52) min, p=0.016) and had a lower oxygen saturation at 5 min (77 (66-92) vs 91 (68-94) %, p=0.028), despite receiving more oxygen (62 (48-76) vs 54 (43-73) %, p=0.036).
CONCLUSIONS: CCA is associated with reduced breathing effort and oxygenation in premature infants at birth.