Yoder M C, Chua R, Tepper R
Department of Pediatrics, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis 46223.
Am Rev Respir Dis. 1991 May;143(5 Pt 1):1044-8. doi: 10.1164/ajrccm/143.5_Pt_1.1044.
Seventeen ventilator-dependent premature infants with bronchopulmonary dysplasia (BPD) were enrolled in a double-blind, placebo-controlled study to determine the effects of 3 days of intravenously administered dexamethasone (0.5 mg/kg/day) on pulmonary function, pulmonary inflammation, and the requirement for respiratory support (FIO2, ventilator peak pressure [PP], and respiratory rate [RR]). Assessment of pulmonary function included measurement of FVC, flow at 25% vital capacity (V25), and static compliance of the respiratory system (Crs), whereas pulmonary inflammation was assessed by the neutrophil count, ratio of elastase/2 x alpha-1-antitrypsin, and the concentrations of albumin and fibronectin in the tracheobronchial lavage (TBL) fluid. After 3 days of placebo treatment there were no significant changes in any of the measured parameters. In contrast, the dexamethasone-treated group demonstrated a significant decrease in respiratory support (FIO2: 50 versus 36%; PP: 21 versus 16 cm H2O; RR: 22 versus 14 breaths/min) and improved pulmonary function (Crs: 0.63 versus 0.85 ml/cm H2O/kg; V25: 23 versus 68 ml/s/kg). In addition, pulmonary inflammation was suppressed in the dexamethasone-treated group (neutrophils: 23 versus 11 x 10(4)/mg albumin: elastase/2 x alpha-1-antitrypsin: 0.24 versus 0.10; albumin: 7.1 versus 3.5 mg/dl; fibronectin: 33 versus 17 micrograms/mg albumin). We conclude that short-term treatment with dexamethasone improves pulmonary function and suppresses pulmonary inflammation as well as decreasing the respiratory support required by ventilator-dependent premature infants with BPD.
17名患有支气管肺发育不良（BPD）且依赖呼吸机的早产儿被纳入一项双盲、安慰剂对照研究，以确定静脉注射地塞米松（0.5毫克/千克/天）3天对肺功能、肺部炎症以及呼吸支持需求（吸入氧分数[FIO2]、呼吸机峰值压力[PP]和呼吸频率[RR]）的影响。肺功能评估包括测量用力肺活量（FVC）、25%肺活量时的流速（V25）以及呼吸系统静态顺应性（Crs），而肺部炎症则通过中性粒细胞计数、弹性蛋白酶/2×α-1抗胰蛋白酶比值以及气管支气管灌洗（TBL）液中白蛋白和纤连蛋白的浓度来评估。安慰剂治疗3天后，任何测量参数均无显著变化。相比之下，地塞米松治疗组的呼吸支持显著降低（FIO2：50%对36%；PP：21厘米水柱对16厘米水柱；RR：22次/分钟对14次/分钟），肺功能得到改善（Crs：0.63毫升/厘米水柱/千克对0.85毫升/厘米水柱/千克；V25：23毫升/秒/千克对68毫升/秒/千克）。此外，地塞米松治疗组的肺部炎症受到抑制（中性粒细胞：23×10⁴/毫克对11×10⁴/毫克；白蛋白：弹性蛋白酶/2×α-1抗胰蛋白酶：0.24对0.10；白蛋白：7.1毫克/分升对3.5毫克/分升；纤连蛋白：33微克/毫克白蛋白对17微克/毫克白蛋白）。我们得出结论，地塞米松短期治疗可改善肺功能、抑制肺部炎症，并减少患有BPD且依赖呼吸机的早产儿所需的呼吸支持。
