支气管肺发育不良的预防和治疗

崔红; 王新宝

doi:10.11852/zgetbjzz2019-0830

PDF(522 KB)

中国儿童保健杂志 ›› 2019, Vol. 27 ›› Issue (10) : 1050-1053. DOI: 10.11852/zgetbjzz2019-0830

专家笔谈

支气管肺发育不良的预防和治疗

崔红, 王新宝

作者信息 +

Progress on the prevention and treatment of bronchopulmonary dysplasia

CUI Hong, WANG Xin-bao

Author information +

文章历史 +

摘要

支气管肺发育不良(BPD)是导致新生儿死亡的重要原因之一,也是早产儿常见的慢性肺疾病。自1967年首次报道以来,五十余年中仍缺乏有效的治疗方法。高浓度氧、气压伤、容积伤和感染是导致早产儿发育不成熟肺损伤的重要原因,产前激素的应用及抗感染有利于降低早产的发生,早产儿生后积极的营养支持、限制液体入量及采用保护性通气策略有利于减轻肺损伤,一氧化氮吸入治疗对支气管肺发育不良的作用研究尚不一致,目前认为维生素A和咖啡因具有预防和治疗支气管肺发育不良的作用,间充质干细胞正在探索用于支气管肺发育不良的治疗。

Abstract

Bronchopulmonary dysplasia(BPD) is one of the important causes for of neonatal death and a common chronic lung disease in premature infants.Since first reported in 1967, there is still no effective treatment over the past 50 years.High concentration of oxygen, barotrauma, volumetric injury and infection are the important causes for immature lung injury in premature infants.The application of prenatal hormones and anti-infection are helpful to reduce the incidence of premature birth.Positive nutritional support and protective ventilation strategy are beneficial to reduce lung injury.However, the current research Results on the effect of nitric oxide inhalation therapy on BPD are still inconsistent.It is believed that vitamin A and caffeine can prevent and treat BPD, and mesenchymal stem cells are currently being explored on the treatment of BPD.

导出引用

崔红, 王新宝. 支气管肺发育不良的预防和治疗[J]. 中国儿童保健杂志. 2019, 27(10): 1050-1053 https://doi.org/10.11852/zgetbjzz2019-0830

CUI Hong, WANG Xin-bao. Progress on the prevention and treatment of bronchopulmonary dysplasia[J]. Chinese Journal of Child Health Care. 2019, 27(10): 1050-1053 https://doi.org/10.11852/zgetbjzz2019-0830

中图分类号： R722.6

参考文献

[1] Northway WH, Rosan RC, Porter DY.Pulmonary disease following respirator therapy of hyaline-membrane disease.Bronchopulmonary dysplasia[J].N Engl J Med,1967,276(7):357-368.
[2] Jobe AJ.The new BPD: an arrest of lung development[J].Pediatr Res,1999,46(6):641-643.
[3] Jobe AH, Bancalari E.Bronchopulmonary dysplasia[J].Am J Respir Crit Care Med,2001,163:1723-1729.
[4] Travers CP, Carlo WA, McDonald SA, et al.Mortality and pulmonary outcomes of extremely preterm infants exposed to antenatal corticosteroids[J].Am J Obstet Gynecol,2018,218:130.
[5] Sweet DG, Carnielli V, Greisen G, et al.European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants--2013 update[J].Neonatology,2013,103,353-368.
[6] Anaka S, Tsumura K, Nakura Y, et al.New antibiotic regimen for preterm premature rupture of membrane reduces the incidence of bronchopulmonary dysplasia[J].J Obstet Gyna ecol Res,2019,45(5):967-973.
[7] Sweet DG, Carnielli V, Greisen G, et al.European consensus guidelines on the management of respiratory distress syndrome-2019 update[J].Neonatology,2019,115(4):432-451.
[8] Oh W, Poindexter BB, Perritt R, et al.Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants[J].J Pediatr,2005,147(6):786-790.
[9] Brion LP, Primhak RA.Intravenous or enteral loop diuretics for preterm infants with(or developing) chronic lung disease[J].Cochrane Database Syst Rev,2011,9:CD001453.
[10] Greenberg RG, Gayam S, Savage D, et al.Furosemide exposure and prevention of bronchopulmonary dysplasia in premature infants[J].J Pediatr,2019,208:134-140.
[11] Albertine KH, Dahl MJ, Gonzales LW, et al.Chronic lung disease in preterm lambs: effect of daily vitamin A treatment on alveolarization[J].Am J Physiol Lung Cell Mol Physiol,2010,299(1):59-72.
[12] Araki S, Kato S, Namba F, et al.Vitamin A to prevent bronchopulmonary dysplasia in extremely low birth weight infants: a systematic review and meta-analysis[J].PLoS One,2018,13(11):e0207730.
[13] Darlow BA, Graham PJ,Rojas-Reyes MX.Vitamin A supplementation to prevent mortality and short-and long-term morbidity in very low birth weight infants[J].Cochrane Database of Syst Rev,2016,8:CD000501.
[14] Stevens TP, Harrington EW, Blennow M, et al.Early surfactant administration with brief ventilation vs.selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome [J].Cochrane Database Syst Rev,2007,4:CD003063.
[15] Isayama T, Iwami H, McDonald S, et al.Association of noninvasive ventilation strategies with mortality and bronchopulmonary dysplasia among preterm infants: a systematic review and meta-analysis[J].JAMA,2016,316(6):611-624.
[16] Jensen EA, Schmidt B.Epidemiology of bronchopulmonary dysplasia[J].Birth Defects Res A Clin Mol Teratol,2014,100(3):145-157.
[17] Tropea K, Christou H.Current pharmacologic approaches for prevention and treatment of bronchopulmonary dysplasia[J].Int J Pediatr,2012,2012:598606.
[18] Bassler D.Inhaled budesonide for the prevention of bronchopulmonary dysplasia[J].J Matern Fetal Neonatal Med,2017,30(19):2372-2374.
[19] Bassler D, Plavka R, Shinwell ES, et al.Early inhaled budesonide for the prevention of bronchopulmonary dysplasia[J].N Engl J Med,2015,373(16):1497-1506.
[20] Doyle LW, Cheong JL, Ehrenkranz RA, et al.Early(< 8 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants[J].Cochrane Database Syst Rev,2017,10:CD001146.
[21] Doyle LW, Cheong JL, Ehrenkranz RA, et al.Late(> 7 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants[J].Cochrane Database Syst Rev,2017,10:CD001145.
[22] Shrestha B, Jawa G.Caffeine citrate-is it a silver bullet in neonatology? [J] Pediatr Neonatol,2017,58(5):391-397.
[23] Jensen EA, Foglia EE, Schmidt B.Evidence-based pharmacologic therapies for prevention of bronchopulmonary dysplasia: application of the grading of recommendations assessment, development, and evaluation methodology[J].Clin Perinatol,2015,42(2):755-779.
[24] Ballard RA, Truog WE, Cnaan A, et al.Inhaled nitric oxide in preterm infants undergoing mechanical ventilation[J].N Engl J Med,2006,355:343-53.
[25] Willis K, Peravali S, Weems M.The death knell of inhaled nitric oxide to prevent bronchopulmonary dysplasia? [J].J Perinatol,2018,38(6):633-635.
[26] Kinsella JP, Steinhorn RH, Krishnan US, et al.Recommendations for the use of inhaled nitric oxide therapy in premature newborns with severe pulmonary hypertension[J].J Pediatr,2016,170:312-314.
[27] Balasubramaniam V, Mervis CF, Maxey AM, et al.Hyperoxia reduces bone marrow, circulating, and lung endothelial progenitor cells in the developing lung: implications for the pathogenesis of bronchopulmonary dysplasia[J].Am J Physiol Lung Cell Mol Physiol,2007,292(5):L1073-L1084.
[28] Porzionato A, Zaramella P, Dedja A, et al.Intratracheal administration of clinical-grade mesenchymal stem cell-derived extracellular vesicles reduces lung injury in a rat model of bronchopulmonary dysplasia[J].Am J Physiol Lung Cell Mol Physiol,2019,316(1):L6-L19.
[29] Mandell EW, Kratimenos P, Abman SH, et al.Drugs for the prevention and treatment of bronchopulmonary dysplasia[J].Clin Perinatol,2019,46(2):291-310.
[30] Ahn SY, Chang YS, Kim JH, et al.Two-year follow-up outcomes of premature infants enrolled in the phase I trial of mesenchymal stem cells transplantation for bronchopulmonary dysplasia[J].J Pediatr,2017,185:49-54.
[31] Chang YS, Ahn SY, Yoo HS, et al.Mesenchymal stem cells for bronchopulmonary dysplasia: phase 1 dose-escalation clinical trial[J].J Pediatr,2014,164(5):966-972.