早产儿呼吸暂停诊治进展

Advances in apnea of prematurity

新生儿原发性呼吸暂停最主要的原因是早产,即早产儿呼吸暂停(AOP),也是目前新生儿重症监护中面临的主要临床问题之一。AOP的发病机制仍不清楚,目前多倾向于与早产儿呼吸中枢发育尚不完善有关,对低氧、高碳酸血症的呼吸反应不成熟,肺牵张反射过度抑制以及中枢神经介质在AOP的发生发展中起重要作用。而某些中枢神经系统和感染性疾病及早产儿行为状态可能诱发或加重呼吸暂停的发生。俯卧位、甲基黄嘌呤类药物和持续气道正压通气(CPAP)是治疗AOP的主要方法。其他治疗方法包括CO2吸入、输血以及触觉刺激等的临床应用仍需进一步研究。文章就新生儿呼吸暂停的发病机制以及治疗策略的最新研究进展进行综述。

Apnea of prematurity（AOP）,commonly affecting premature infants,is one of the main clinical problems in neonatal intensive care unit.The mechanism of AOP pathogenesis is not clear,with speculation currently focuses on prematurity of respiratory center in preterm infants.Other important factors include altered ventilatory responses to hypoxia and hypercapnia,overinhibition of pulmonary stretch reflex and hypersensitivity to inhibitory neurotransmitters.In addition,neonatal diseases may play an additive role in increasing the incidence of apnea.Standard clinical management of AOP includes prone positioning,continuous positive or nasal intermittent positive pressure ventilation and methylxanthine therapy.Other therapies,including sensory stimulations,red blood cell transfusions,and CO2 inhalation require further study.This review focuses on the insights into the pathogenesis basis for AOP,and the mechanisms underlying for its therapies.