预防和管理支气管肺发育不良的通气策略
Ventilatory strategies in the prevention and management of bronchopulmonary dysplasia.
作者信息
Ambalavanan Namasivayam, Carlo Waldemar A
机构信息
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
出版信息
Semin Perinatol. 2006 Aug;30(4):192-9. doi: 10.1053/j.semperi.2006.05.006.
Bronchopulmonary dysplasia (BPD) leads to considerable mortality and morbidity in premature infants. Although mechanical ventilation is lifesaving in infants with respiratory distress syndrome (RDS), it may contribute to lung injury and subsequently to BPD. Appropriate ventilatory strategies for reducing BPD include redefining the goals for "adequate gas exchange," using less mechanical ventilation support, refining the methods of mechanical ventilation, and using alternative techniques. Permissive hypercapnia, permissive hypoxemia, minimal peak pressures, rapid rates, early therapeutic continuous positive airway pressure (CPAP), and rapid extubation may help reduce mechanical ventilation-induced lung injury and possibly reduce BPD. Newer techniques of ventilation such as volume-targeted ventilation are also promising. High frequency ventilation has not been proven to reduce BPD. There is a lack of evidence-based guidelines on management of infants with established BPD. Optimization of clinical care practices and ancillary therapies need to be combined with ventilatory strategies to prevent and manage BPD.
支气管肺发育不良(BPD)导致早产儿出现相当高的死亡率和发病率。尽管机械通气对患有呼吸窘迫综合征(RDS)的婴儿有救命作用,但它可能会导致肺损伤,进而引发BPD。减少BPD的适当通气策略包括重新定义“充分气体交换”的目标、减少机械通气支持的使用、改进机械通气方法以及采用替代技术。允许性高碳酸血症、允许性低氧血症、最小峰压、快速频率、早期治疗性持续气道正压通气(CPAP)以及快速拔管可能有助于减少机械通气引起的肺损伤,并有可能降低BPD的发生率。诸如容量目标通气等更新的通气技术也很有前景。高频通气尚未被证明能降低BPD的发生率。对于已确诊BPD的婴儿,缺乏基于证据的管理指南。优化临床护理实践和辅助治疗需要与通气策略相结合,以预防和管理BPD。