극소저체중 출생아에서 고이산화탄소혈증에 대한 대사성 보상이 일어나는 시기
The Time When the Metabolic Compensation for Hypercapnia Begin to Occur in Very Low Birth Weight Infants
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목적: 인공환기로 인한 폐손상은 기관지폐 형성이상의 주요 병인 중 하나이다. 관용적 고이산화탄소혈증은 폐손상을 줄이기 위한 치료 정책 중 하나이다. 하지만 극소 저출생 체중아에서는 호흡성 산증에 따른 대사성 보상이 미숙하여종종 관용적 고이산화탄소혈증을 적용하기가 어렵다. 본 연구는 극소저체중 출생아에서 과이산화탄소혈증에 대한 대사성 보상이 일어나는 시점을 알아보기 위해 고안되었다. 방법: 2011년 1월부터 2012년 12월까지 분당서울대학교병원에 입원한 출생 체중 1,500g 미만 환아 82명의 의무기록을 대상으로 후향적으로 조사하였다. pCO2 40 mmHg 이상에서 HCO3-의 기대값과 실제값의 차이가 2.0 mmol/L 이하로나타나는 출생 후 날짜를 관용적 고이산화탄소혈증에 의한 대사성 보상이 일어난 날로 정의하였다. 결과: 극소저체중 출생아에서 대사성 보상이 일어난 출생 후 날짜의 평균은 9.1±3.9일이었다. 재태 연령이 어리거나 출생 체중이 작을수록, 대사성 보상이 나중에 나타났다. 또한 대사성 보상이 늦게 일어난 군(≥9 days)이 일찍 일어난군(<9 days)에 비해 재태 연령이 어렸고(P=0.001) 출생체중이 작았으며(P=0.041), 기관삽관을 오래 하였고(P=0.002)RDS의 유병률이 높았다(P=0.036). 그러나 로지스틱 회귀분석을 시행했을 때는 유의한 차이를 보이지 않았으며재태 연령만이 경계적으로 유의하였다(P=0.068). 결론: 극소저체중 출생아에서의 고이산화탄소혈증에 대한 대사성 보상은 평균적으로 생후 9일부터 나타나기 시작하였다. 따라서 극소 미숙아의 호흡기 치료에서 폐손상을 줄이기 위해 적용하는 관용적 고이산화탄소혈증은 대사성보상이 일어난 이후부터 시도되어야 할 것으로 보인다.
Abstract
Purpose: Lung injury from mechanical ventilation is one of the major pathogenetic factors of bronchopulmonary dysplasia. Permissive hypercapnia (PH) is one of the strategies for reducing lung injury. However, PH is frequently infeasible in very low birth weight infants (VLBWI) due to their immature renal compensation for respiratory acidosis. The purpose of this study was to identify time when metabolic compensation for hypercapnia begin to occur in VLBWIs. Methods: Data were retrospectively collected from 82 VLBWI who were admitted to Seoul National University Bundang Hospital from January 2011 to December 2012. The postnatal day when the difference between actual bicarbonate and expected bicarbonate levels became less than 2.0 mmol/L consistently for the first time under hypercapnea (>40 mmHg) was defined as the time when metabolic compensation for hypercapnea occurred. Results: Metabolic compensation for hypercapnea occurred on 9.1±3.9 postnatal day. The younger the gestational age (GA) was and the smaller the birth weight was, the later metabolic compensation for hypercapnea occurred. Late metabolic compensators (≥9 days) were significantly younger in GA (P=0.001), lighter at birth (P=0.041), intubated longer (P=0.002), and less frequently afflicted with respiratory distress syndrome (P=0.036) compared to early metabolic compensators (<9 days). However, logistic regression analysis revealed only young GA was associated with late metabolic compensation with marginal significance (P=0.068). Conclusion: Metabolic compensation for hypercapnea occurred 9 days after birth on average. PH strategy for reducing lung injury should be considered after renal metabolic compensation for hypercapnea occurs in VLBWI.
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