早产儿初始呼吸管理与支气管肺发育不良
Initial respiratory management in preterm infants and bronchopulmonary dysplasia.
机构信息
Hospital General Universitario Gregorio Marañón - Neonatology, Madrid, Spain.
出版信息
Clinics (Sao Paulo). 2011;66(5):823-7. doi: 10.1590/s1807-59322011000500019.
BACKGROUND
Ventilator injury has been implicated in the pathogenesis of bronchopulmonary dysplasia. Avoiding invasive ventilation could reduce lung injury, and early respiratory management may affect pulmonary outcomes.
OBJECTIVE
To analyze the effect of initial respiratory support on survival without bronchopulmonary dysplasia at a gestational age of 36 weeks.
DESIGN/METHODS: A prospective 3-year observational study. Preterm infants of <32 weeks gestational age were classified into 4 groups according to the support needed during the first 2 hours of life: room air, nasal continuous positive airway pressure, intubation/surfactant/extubation and prolonged mechanical ventilation (defined as needing mechanical ventilation for more than 2 hours).
RESULTS
Of the 329 eligible patients, a total of 49% did not need intubation, and 68.4% did not require prolonged mechanical ventilation. At a gestational age of 26 weeks, there was a significant correlation between survival without bronchopulmonary dysplasia and initial respiratory support. Preterm infants requiring mechanical ventilation showed a higher risk of death and bronchopulmonary dysplasia. After controlling for gestational age, antenatal corticosteroid use, maternal preeclampsia and chorioamnionitis, the survival rate without bronchopulmonary dysplasia remained significantly lower in the mechanically ventilated group.
CONCLUSIONS
In our population, the need for more than 2 hours of mechanical ventilation predicted the development of bronchopulmonary dysplasia in preterm infants with a gestational age >26 weeks (sensitivity =89.5% and specificity = 67%). The need for prolonged mechanical ventilation could be an early marker for the development of bronchopulmonary dysplasia. This finding could help identify a target population with a high risk of chronic lung disease. Future research is needed to determine other strategies to prevent bronchopulmonary dysplasia in this high-risk group of patients.
背景
呼吸机相关性肺损伤与支气管肺发育不良的发病机制有关。避免有创通气可以减少肺损伤，早期呼吸管理可能会影响肺部结局。
目的
分析初始呼吸支持对胎龄 36 周时无支气管肺发育不良的存活者的影响。
设计/方法：一项前瞻性 3 年观察性研究。根据生命最初 2 小时内所需的支持，将<32 周胎龄的早产儿分为 4 组：空气、经鼻持续气道正压通气、插管/表面活性物质/拔管和长时间机械通气（定义为需要机械通气超过 2 小时）。
结果
在 329 名符合条件的患者中，共有 49%的患者不需要插管，68.4%的患者不需要长时间机械通气。在 26 周胎龄时，无支气管肺发育不良的存活率与初始呼吸支持有显著相关性。需要机械通气的早产儿死亡和支气管肺发育不良的风险更高。在控制胎龄、产前使用皮质类固醇、母亲子痫前期和绒毛膜羊膜炎后，无支气管肺发育不良的存活率在机械通气组仍显著较低。
结论
在我们的人群中，需要超过 2 小时的机械通气预测了胎龄>26 周的早产儿发生支气管肺发育不良（敏感性=89.5%，特异性=67%）。需要长时间机械通气可能是支气管肺发育不良发展的早期标志物。这一发现可以帮助确定患有慢性肺部疾病风险较高的目标人群。需要进一步研究以确定其他预防该高风险患者支气管肺发育不良的策略。
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