Rutkowska M, Helwich E, Rudzinska-Chazan M
Klinika Patologii i Intensywnej Terapii Noworodka, Instytut Matki i Dziecka w Warszawie, ul. Kasprzaka 17a, 01-211 Warszawa, Polska.
Med Wieku Rozwoj. 2000;4(2 Suppl 3):43-57.
The mortality of very preterm infants has significantly improved after introducing into clinical practice the antenatal use of glucocorticoid steroids prior to premature births and postnatal treatment with pulmonary surfactant which effectively decreases the tendency of the alveoli to collapse. The period of necessary mechanical ventilation was shortened. Reducing the concentration of inspired oxygen and inflation pressures became possible. In spite of this, long-term damage of lung tissue in immature infants is still a major clinical problem. However, its origin seems to be slightly different. A new form of bronchopulmonary dysplasia (BPD) has been recently evaluated. The most important factors in the pathogenesis of the "new" BPD are: lung tissue immaturity, infections initiating a cascade of events caused by formation of free oxygen radicals and cytokines and the presence of persistent patent ductus arteriosus. Primary prevention of BPD is possible by reducing the rates of prematurity and intrauterine infections. Secondary prevention includes antenatal steroids administration and postnatal surfactant treatment according to the accepted known standards. When protracted mechanical ventilation is necessary, low and subsequently reduced doses of i.v. glucocorticoid steroids in the second and third week of life are administrated, together with diuretics, bronchodilators and suitably high calorie feeding.
在临床实践中引入早产前产前使用糖皮质激素以及产后使用肺表面活性物质进行治疗后，极早产儿的死亡率显著改善，肺表面活性物质可有效降低肺泡塌陷的倾向。必要的机械通气时间缩短了。降低吸入氧浓度和充气压力成为可能。尽管如此，未成熟婴儿肺组织的长期损伤仍然是一个主要的临床问题。然而，其起源似乎略有不同。最近对一种新形式的支气管肺发育不良（BPD）进行了评估。“新”BPD发病机制中最重要的因素是：肺组织不成熟、感染引发由游离氧自由基和细胞因子形成导致的一系列事件以及动脉导管未闭持续存在。通过降低早产率和宫内感染率可以对BPD进行一级预防。二级预防包括按照公认的已知标准进行产前类固醇给药和产后表面活性物质治疗。当需要长时间机械通气时，在出生后第二周和第三周静脉注射低剂量随后逐渐减少剂量的糖皮质激素，同时使用利尿剂、支气管扩张剂和热量适当高的喂养。
