早产儿通气、氧化应激与脑损伤风险
Ventilation, oxidative stress and risk of brain injury in preterm newborn.
机构信息
Department of Human Pathology of Adulthood and Childhood, University of Messina, UOC di Pediatria, Pad. NI, 3° piano, AOU Policlinico Gaetano Martino, Via Consolare Valeria, 1, 98125, Messina, Italy.
Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy.
出版信息
Ital J Pediatr. 2020 Jul 23;46(1):100. doi: 10.1186/s13052-020-00852-1.
Preterm infants have an increased risk of cognitive and behavioral deficits and cerebral palsy compared to term born babies. Especially before 32 weeks of gestation, infants may require respiratory support, but at the same time, ventilation is known to induce oxidative stress, increasing the risk of brain injury. Ventilation may cause brain damage through two pathways: localized cerebral inflammatory response and hemodynamic instability. During ventilation, the most important causes of pro-inflammatory cytokine release are oxygen toxicity, barotrauma and volutrauma. The purpose of this review was to analyze the mechanism of ventilation-induced lung injury (VILI) and the relationship between brain injury and VILI in order to provide the safest possible respiratory support to a premature baby. As gentle ventilation from the delivery room is needed to reduce VILI, it is recommended to start ventilation with 21-30% oxygen, prefer a non-invasive respiratory approach and, if mechanical ventilation is required, prefer low Positive End-Expiratory Pressure and tidal volume.
早产儿与足月儿相比，认知和行为缺陷以及脑瘫的风险增加。特别是在妊娠 32 周之前，婴儿可能需要呼吸支持，但同时，通气已知会引起氧化应激，增加脑损伤的风险。通气可能通过两种途径造成脑损伤：局部脑炎症反应和血流动力学不稳定。在通气过程中，促炎细胞因子释放的最重要原因是氧毒性、气压伤和容积伤。本综述的目的是分析通气引起的肺损伤（VILI）的机制以及脑损伤与 VILI 之间的关系，以便为早产儿提供尽可能安全的呼吸支持。由于需要从分娩室开始进行温和通气以减少 VILI，因此建议用 21-30%的氧气开始通气，优先选择非侵入性呼吸方法，如果需要机械通气，则优先选择低呼气末正压和潮气量。
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