Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA.
Neonatology. 2012;102(1):1-8. doi: 10.1159/000336030. Epub 2012 Feb 18.
When bronchopulmonary dysplasia (BPD) was first described in 1967, the use of assisted ventilation in neonates was in its infancy. High concentrations of oxygen were implicated, and BPD was equated with 'pulmonary oxygen toxicity'. The etiologic role of not only oxygen but also peak inspiratory pressures and the duration of exposure to both was emphasized in the 1970s, but BPD remained a dreaded complication of managing respiratory distress syndrome in the 1980s. It was only after exogenous surfactant became commercially available for endotracheal administration that 'classical' BPD began to disappear and was replaced by the 'new' BPD. 'Classical' BPD was seen in more mature preterm infants (>28 weeks' gestational age) and in its severe form was characterized radiographically by micro- and macrocysts of the lung, lung hyperinflation and flattening of the diaphragms. In contrast, 'new' BPD is seen in less mature infants (<28 weeks' gestational age), has comparatively mild radiographic abnormalities and has been defined as continued oxygen requirement at 36 weeks' postmenstrual age. Pathologically, 'classical' BPD frequently revealed obstructive bronchiolitis and fibrosis of lung parenchyma, whereas 'new' BPD demonstrates minimal fibrosis but uniform arrest of development. Herein, factors which may contribute to the etiology of BPD are described, as well as possible preventative and therapeutic strategies.
当支气管肺发育不良（BPD）于 1967 年首次被描述时，新生儿辅助通气的应用还处于起步阶段。高浓度氧气被认为与此有关，BPD 等同于“肺氧毒性”。20 世纪 70 年代，不仅氧气，而且吸气峰压以及暴露于两者的时间长短的发病作用都得到了强调，但 BPD 在 20 世纪 80 年代仍然是治疗呼吸窘迫综合征的可怕并发症。只有在外源性表面活性剂可商购用于气管内给药后，“经典”BPD 才开始消失，并被“新”BPD 所取代。“经典”BPD 见于更成熟的早产儿（>28 周胎龄），其严重形式在影像学上表现为肺的微囊和大囊、肺过度充气和横膈膜平坦。相比之下，“新”BPD 见于不成熟的婴儿（<28 周胎龄），其影像学异常相对较轻，并被定义为在出生后 36 周仍需要吸氧。从病理上看，“经典”BPD 常表现为阻塞性细支气管炎和肺实质纤维化，而“新”BPD 则表现为最小程度的纤维化，但发育均匀停止。在此，描述了可能导致 BPD 病因的因素，以及可能的预防和治疗策略。
