Rawat Munmun, Lakshminrusimha Satyan, Vento Maximo
Department of Pediatrics, University at Buffalo, Buffalo, NY, USA.
Department of Pediatrics, UC Davis Children's Hospital, Sacramento, CA, USA.
Semin Fetal Neonatal Med. 2022 Aug;27(4):101347. doi: 10.1016/j.siny.2022.101347. Epub 2022 Apr 19.
Oxidative stress can be associated with hyperoxia and hypoxia and is characterized by an increase in reactive oxygen (ROS) and nitrogen (RNS) species generated by an underlying disease process or by supplemental oxygen that exceeds the neutralization capacity of the organ system. ROS and RNS acting as free radicals can inactive several enzymes and vasodilators in the nitric oxide pathway promoting pulmonary vasoconstriction resulting in persistent pulmonary hypertension of the newborn (PPHN). Studies in animal models of PPHN have shown high ROS/RNS that is further increased by hyperoxic ventilation. In addition, antioxidant therapy increased PaO in these models, but clinical trials are lacking. We recommend targeting preductal SpO between 90 and 97%, PaO between 55 and 80 mmHg and avoiding FiO > 0.6-0.8 if possible during PPHN management. This review highlights the role of oxidative and nitrosative stress markers on PPHN and potential therapeutic interventions that may alleviate the consequences of increased oxidant stress during ventilation with supplemental oxygen.
氧化应激可能与高氧和低氧有关，其特征是潜在疾病过程或超过器官系统中和能力的补充氧气所产生的活性氧（ROS）和活性氮（RNS）增加。作为自由基的ROS和RNS可使一氧化氮途径中的几种酶和血管舒张剂失活，促进肺血管收缩，导致新生儿持续性肺动脉高压（PPHN）。PPHN动物模型研究表明，高氧通气会进一步增加ROS/RNS水平。此外，抗氧化治疗可提高这些模型中的动脉血氧分压（PaO），但缺乏临床试验。我们建议在PPHN管理期间，将导管前血氧饱和度（SpO）目标设定在90%至97%之间，PaO在55至80mmHg之间，并尽可能避免吸入氧浓度（FiO）>0.6 - 0.8。本综述强调了氧化和亚硝化应激标志物在PPHN中的作用以及可能减轻补充氧气通气期间氧化应激增加后果的潜在治疗干预措施。
