기계적 환기 요법을 시행 받은 미숙아에서 고탄산혈증과 뇌실내 출혈의 발생과의 관계

Abstract

PURPOSE: The aim of this study was to examine whether hypercapnia during the first seven days of life was associated with severe intraventricular hemorrhage (IVH) in preterm infants requiring mechanical ventilation. METHODS: A matched pair analysis was performed for 19 preterm infants with severe IVH (grade> or =3) and 38 infants with no severe IVH (normal or grade 1), who required mechanical ventilation for more than seven days. The univariate and multivariate analysis of severe IVH with maximal and minimal PaCO2, averag PaCO2, SD of PaCO2, and difference in the PaCO2 were assessed. The major perinatal factors and maximal ventilator index (VI) were also compared. RESULTS: Infants with severe IVH had a higher maximal PaCO2 (86.1+/-18.4 mmHg vs. 60.1+/-11.6 mmHg, P<0.001) and mean PaCO2 (47.5+/-5.6 mmHg vs. 41.2+/-6.3 mmHg, P=0.004) and a larger SD or difference in PaCO2 (14.0+/-4.4 mmHg vs. 9.0+/-2.4 mmHg; 60.3+/-20.9 mmHg vs. 35.5+/-11.8 mmHg, P<0.001). However the minimal PaCO2 values did not differ between the groups. Disseminated intravascular coagulation, pulmonary hemorrhage, and the air leak syndrome were more frequent in the IVH group than in the controls. The maximal VI on each day was higher in the IVH group. The multivariate logistic regression analysis after controlling for bleeding tendency showed that the air leak syndrome, maximal VI, and maximal PaCO2 were independently associated with severe IVH [OR, 1.324 (95% CI, 1.011-1.733; P=0.041)]. CONCLUSION: Extreme hypercapnia was significantly associated with severe IVH in preterm infants, after adjustment for major perinatal risk factors. Frequent monitoring of the PaCO2 may be important for early detection of inadvertent hypercapnia and prompt correction of high PaCOS levels