持续性肺膨胀在早产儿复苏中应用的研究进展

Sustained lung inflation in resuscitation of premature infants:a review

自主呼吸的建立是胎儿向新生儿过渡的关键。部分新生儿,尤其是早产儿,需要呼吸支持以实现这一过渡。根据健康足月儿生后最初几次深呼吸产生的气道压力变化,持续性肺膨胀(sustained lung inflation,SLI)的通气策略能够促进肺内液体的清除及功能残气量的维持以改善呼吸功能,这也得到了动物研究和临床研究的证实。但另有部分研究认为SLI可能并无益处,甚至可能增加早产儿的病死率,这使SLI在早产儿复苏中的应用备受争议。因此,目前尚不推荐将SLI常规应用于临床。由于不同胎龄早产儿出生时肺成熟度、自主呼吸能力不同,SLI的效果也存在差异,仍需更多的研究探索SLI的效果及安全性。本文对SLI在早产儿复苏的应用以及相关研究进展进行了综述。

The establishment of spontaneous breathing plays an essential role in the intrauterine to extrauterine transition.Sometimes respiratory support is needed during this transition,especially for preterm infants.Animal and clinical studies have indicated that based on the changes in the airway pressure caused by the first few deep breaths in full-term infants,sustained lung inflation(SLI)could improve respiratory function by facilitating the removal of the lung fluid and maintain functional residual capacity.However,the study results of SLI's effectiveness are inconsistent,and some even demonstrated that SLI could increase the case fatality rate in extremely premature infants.Thus,SLI in resuscitation for premature infants is controversial and is not recommended as a routine practice for preterm infants.The effects of SLI vary due to the differences in lung maturity and spontaneous breathing ability of preterm infants with different gestational ages.Further studies are needed to investigate the effectiveness and safety of SLI.This article reviews the application and the latest progress of SLI in premature infants.