Kössel H, Versmold H
Department of Pediatrics, Benjamin Franklin University Hospital, Free University of Berlin, Fed. Rep. of Germany.
J Perinat Med. 1997;25(5):421-32.
Respiratory support of newborn infants has changed in the last 25 years, because of new knowledge of patho-physiology, controlled studies of respiratory therapy and the realisation of perinatal centers. Respiratory support has changed from the "blow in--suck out" approach, inevitably leading to severe atelectasis, high morbidity and mortality to a now very sophisticated therapy with reduced mortality and morbidity also in very-low-birth-weight infants, who were hopeless patients 25 years ago. Major milestones of this development were the introduction of continuous distending pressure to surfactant deficient lungs, the high-frequency positive pressure ventilation with fine tuning of inspiratory and expiratory times, adjusted to individual time constants and the substitution of artificial surfactant. Techniques for the future, like HFO, NO-inhalation, proportional assist ventilation and liquid ventilation are presently investigated.
在过去25年里，由于病理生理学新知识、呼吸治疗的对照研究以及围产期中心的建立，新生儿的呼吸支持发生了变化。呼吸支持已从“吹入-吸出”方法（这种方法不可避免地导致严重肺不张、高发病率和死亡率）转变为如今非常复杂的治疗方法，即使是极低出生体重儿的死亡率和发病率也有所降低，而在25年前这些患儿还是无望治愈的患者。这一发展的主要里程碑包括对表面活性物质缺乏的肺应用持续扩张压力、对吸气和呼气时间进行微调的高频正压通气（根据个体时间常数进行调整）以及人工表面活性物质的替代。目前正在研究未来的技术，如高频振荡通气、一氧化氮吸入、比例辅助通气和液体通气。
