早产儿肺高压的氧疗。
Oxygen therapy in preterm infants with pulmonary hypertension.
机构信息
Division of Neonatology, Department of Pediatrics, University at Buffalo, USA.
Division of Neonatology, Department of Pediatrics, University of California, Davis, USA.
出版信息
Semin Fetal Neonatal Med. 2020 Apr;25(2):101070. doi: 10.1016/j.siny.2019.101070. Epub 2019 Dec 3.
Premature neonates <34 weeks gestation can present with early-onset, late-onset and bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PHT), with clinical, echocardiographic, and histological features similar to term infants with PHT. Changes in pulmonary vascular resistance (PVR) in response to oxygen are diminished in preterm infants compared to term. Studies from preterm lambs and human infants with BPD have shown that PaO > 30-55 mm Hg promotes pulmonary vasodilation. Targeting saturations of 80-85% by 5 min, 85-95% by 10 min during resuscitation and 90-95% during the postnatal course are appropriate targets for routine management of preterm infants. Among preterm infants with PHT, avoiding hypoxia/hyperoxia by titrating supplemental oxygen to maintain saturations in low to mid 90s with alarm limits at 90 and 97% seems to be a reasonable approach pending further studies. Further high-quality evidence generated from randomized trials is required to guide oxygen therapy in preterm PHT.
早产儿（<34 周）可发生早发性、晚发性和支气管肺发育不良（BPD）相关肺动脉高压（PHT），其临床、超声心动图和组织学特征与足月婴儿的 PHT 相似。与足月婴儿相比，早产儿对氧的肺血管阻力（PVR）变化降低。来自早产儿羊和患有 BPD 的人类婴儿的研究表明，PaO2>30-55mmHg 可促进肺血管扩张。复苏期间 5 分钟内目标饱和度为 80-85%，10 分钟内目标饱和度为 85-95%，在出生后期间目标饱和度为 90-95%，是早产儿常规管理的合适目标。对于患有 PHT 的早产儿，通过滴定补充氧来避免低氧血症/高氧血症，以维持饱和度在 90 到 95%之间，报警限制为 90%和 97%，似乎是一种合理的方法，有待进一步研究。需要进一步的高质量随机试验证据来指导早产儿 PHT 的氧疗。
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