기관지폐이형성증 영아에서 폐기능 측정의 유용성
Utility of Infant Pulmonary Function Test in Bronchopulmonary Dysplasia
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목 적:건강한 미숙아에서 기관지폐이형성증을 가진 미숙아에 이르기까지 미숙아의 폐기능은 다양한 정도로 감소되어 있다고 알려져 있다. 영아에서 폐기능을 평가하는 방법은 오랜 노력 끝에 표준화되기에 이르렀으나 국내에서 아직까지 연구된 바 없다. 본 연구에서는 만성 폐질환을 가진 미숙아에서 폐기능을 객관적인 평가방법을 통하여 측정하고 폐기능 감소에 영향을 미치는 위험 요인들을 분석하여 그 유용성을 알아보고자 하였다. 방 법:세브란스 어린이병원에서 출생한 54명을 대상으로 하였다. 전체 대상아 중 남자는 31명, 여자는 23명이었고, 평균연령은 5.6±3.7개월이었다. 대상자에서 영아폐기능 측정기구(Exhalyser; EcoMedics, Dürnten, Switzerland)를 이용하여 일회호흡량(tidal volume, TV) 및 기능적잔기량(functional Residual Capacity, FRC)을 측정하였고, 기관지확장제 흡입 후 같은 방법으로 측정하여 변화를 관찰하였다. 전체 대상아에서 검사와 관련된 부작용은 없었다. 결 과:대상 환아 54명 중 22명은 재태주령 28주 미만 출생아, 25명은 28주 이상 33주 미만 출생아, 7명은 33주 이상 37주 미만의 출생아였다. 또한 초극소 저체중출생아 23명, 극소 저체중출생아 23명, 저체중출생아는 8명이었다. 기관지확장제 흡입 전후 기능적잔기량 변화(delta FRC, dFRC)는 재태주령이 어릴수록(P＜0.05), 출생체중이 작을수록(P＜0.05) 의미있게 증가하였다. 기능적잔기량 변화는 재태주령(r=-0.35; P=0.013), 출생체중(r=-0.32; P=0.026)과 유의한 음의 상관관계를, 기계호흡일수(r= 0.42; P=0.0028), 산소치료일수(r=0.43; P=0.0024)와는 양의 상관관계를 보였다. 기관지확장제 흡입 전 기능적잔기량은 출생체중이 작을수록 유의하게 작았으며,(r=0.43; P=0.0013) 기관지확장제 흡입 전 일회호흡량은 기계호흡일수와 음의 상관관계를 나타내었다.(r=-0.39; P= 0.0048)결 론:미숙아에서 출생체중이 작을수록, 재태주령이 어릴수록, 기계호흡일수와 산소치료일수가 길수록 기관지확장제에 의한 기능적잔기량의 가역성이 증가하였다. 기능적잔기량 가역성은 만성 폐질환 미숙아에서 안전하게 측정할 수 있는 유용한 폐기능 지표로 생각된다.
Abstract
Purpose:Pulmonary function is decreased in varying degrees in healthy premature infants as well as those with bronchopulmonary dysplasia. The evaluation of pulmonary function in infants is finally standardized after strenuous efforts, but it has not yet been in Korea. In this study, we aimed at the evaluation of the utility of pulmonary function tests in premature infants with chronic lung disease by objectively measuring pulmonary function and by analyzing the risk factors that may decrease lung function. Methods:Fifty-four premature infants born in Severance Hospital were selected. Among the 54 infants, 31 were male and 23 were female, and their mean age was 5.6±3.7 years. Exhalyser was used to measure tidal volume and functional residual capacity, and then their change after the inhalation of bronchodilators was evaluated. There was no test related complication in all subjects. Results:Among the 54 subjects, 22 were at the gestational age of ＜28 weeks, 25 were at the gestational age between 28 and 33 weeks, and 7 were at the gestational age between 33 and 37 weeks. As for birth weight, 23 had extreme low birth weight, 23 had very low birth weight, and 8 had low birth weight. The delta functional residual capacities (FRCs) before and after the inhalation of bronchodilator were significantly increased in infants with younger gestational age (P＜0.05) and lower birth weight (P＜0.05). There was a significant negative correlation between gestational age and birth weight, and a significant positive correlation with the duration of ventilator care and that of oxygen therapy. The delta FRC before the inhalation of bronchodilator was significantly lower in infants with lower birth weight, and the tidal volume before the inhalation of bronchodilator correlated negatively with the duration of ventilator care. Conclusion:The reversibility of FRC is increased in premature infants with lower birth weight, younger gestational age, and longer duration of ventilator care and oxygen therapy. The reversibility of FRC may be a useful parameter of pulmonary function that can be safely measured in premature infants with chronic lung disease.
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