Kumar Praveen, Kiran P S Sandesh
Neonatal Unit, Department of Pediatrics, Post-Graduate Institute of Medical Education & Research, Chandigarh, India.
Indian J Pediatr. 2004 Jan;71(1):49-54. doi: 10.1007/BF02725656.
The management of respiratory distress syndrome (RDS) has advanced because of improvements in mechanical ventilators, promotion of antenatal steroids, availability of surfactant and overall advancements in neonatal intensive care. Intermittent mandatory ventilation still forms the mainstay of assisted ventilation. Newer modes of ventilation have not delivered the results as promised. Because of the continued high incidence of bronchopulmonary dysplasia, there is a renewed interest in non-invasive modes of ventilation like CPAP and nasal IPPV. The present trend is to follow gentle ventilatory strategies accepting higher arterial carbon dioxide and lower oxygen. The role of antenatal steroids has been established beyond doubt but still they fall short of universal acceptance. Surfactant replacement therapy is the standard of care for RDS but beyond the reach of majority in India. Postnatal steroids are out of vogue because of probable links with cerebral palsy and abnormal neurological outcomes.
由于机械通气设备的改进、产前类固醇激素的推广、表面活性剂的可获得性以及新生儿重症监护的整体进步，呼吸窘迫综合征（RDS）的管理取得了进展。间歇强制通气仍然是辅助通气的主要方式。更新的通气模式并未达到预期效果。由于支气管肺发育不良的发病率持续居高不下，人们对持续气道正压通气（CPAP）和经鼻间歇正压通气（IPPV）等无创通气模式重新产生了兴趣。目前的趋势是采用温和的通气策略，接受较高的动脉二氧化碳分压和较低的氧分压。产前类固醇激素的作用已毋庸置疑，但仍未被普遍接受。表面活性剂替代疗法是治疗RDS的标准方法，但在印度，大多数人无法获得。产后使用类固醇激素已不再流行，因为可能与脑瘫和异常神经结局有关。
