支气管肺发育不良的预防策略

Prevention of bronchopulmonary dysplasia:current strategies

随着近代新生儿学的持续发展和极早早产儿存活率的不断改善,支气管肺发育不良（bronchopulmonary dysplasia,BPD）的定义发生了重大变化。BPD已不再是半个世纪前Nothway等学者提出的因高浓度氧及高压力通气导致的严重呼吸衰竭。新BPD更多发生在极早早产儿中,以损伤发育中的肺及肺血管而产生程度较轻却持续的呼吸问题为表现。由于影响肺及肺血管发育的因素贯穿早产儿产前生后的整个过程,因此对新BPD有效的预防策略应当包含多个角度,共同促进早产儿肺及肺血管的正常发育。近年来,BPD的预防在很多方面都取得了一定的进展,本文在此对部分策略做简单介绍。

Bronchopulmonary dysplasia（BPD） is one of the few diseases affecting premature infants that have continued to evolve since its first description about half a century ago.The current form of BPD,a more benign and protracted respiratory failure in extremely preterm infants,is in contrast to the original presentation of severe respiratory failure with high mortality in larger premature infants.This new BPD is end result of complex interplay of various antenatal and postnatal factors causing lung injury and subsequent abnormal repair leading to altered alveolar and vascular development.The change in clinical and pathologic picture of BPD over time has resulted in new challenges in developing strategies for its prevention and management.While some of these strategies like Vitamin A supplementation,caffeine and volume targeted ventilation have stood the test of time,others like postnatal steroids are being reexamined with great interest in last few years.It is quite clear that BPD is unlikely to be eliminated unless some miraculous strategy cures prematurity.The future of BPD prevention will probably be a combination of antenatal and postnatal strategies acting on multiple pathways to minimize lung injury and abnormal repair as well as promote normal alveolar and vascular development.