Aversa Salvatore, Marseglia Lucia, Manti Sara, D'Angelo Gabriella, Cuppari Caterina, David Antonio, Chirico Gaetano, Gitto Eloisa
Neonatal Intensive Care Unit, Children Hospital, Spedali Civili of Brescia, Brescia, Italy, PhD course in Intensive Care, University of Messina, Messina, Italy.
Department of Pediatrics, University of Messina, Messina, Italy.
Paediatr Respir Rev. 2016 Jan;17:71-9. doi: 10.1016/j.prrv.2015.08.015. Epub 2015 Oct 22.
Reactive oxygen and nitrogen species are produced by several inflammatory and structural cells of the airways. The lungs of preterm newborns are susceptible to oxidative injury induced by both reactive oxygen and nitrogen species. Increased oxidative stress and imbalance in antioxidant enzymes may play a role in the pathogenesis of inflammatory pulmonary diseases. Preterm infants are frequently exposed to high oxygen concentrations, infections or inflammation; they have reduced antioxidant defense and high free iron levels which enhance toxic radical generation. Multiple ventilation strategies have been studied to reduce injury and improve outcomes in preterm infants. Using lung protective strategies, there is the need to reach a compromise between satisfaction of gas exchange and potential toxicities related to over-distension, derecruitment of lung units and high oxygen concentrations. In this review, the authors summarize scientific evidence concerning oxidative stress as it relates to resuscitation in the delivery room and to the strategies of ventilation.
活性氧和氮物质由气道的几种炎性细胞和结构细胞产生。早产新生儿的肺部易受活性氧和氮物质诱导的氧化损伤。氧化应激增加和抗氧化酶失衡可能在炎性肺部疾病的发病机制中起作用。早产儿经常暴露于高氧浓度、感染或炎症中;他们的抗氧化防御能力降低,游离铁水平高,这会增强有毒自由基的产生。已经研究了多种通气策略以减少早产儿的损伤并改善其预后。采用肺保护策略时,需要在气体交换的满意度与与过度扩张、肺单位萎陷和高氧浓度相关的潜在毒性之间达成妥协。在这篇综述中,作者总结了与产房复苏和通气策略相关的氧化应激的科学证据。