糖皮质激素在新生儿支气管肺发育不良中应用的研究进展

Research progress on the application of glucocorticoids in bronchopulmonary dysplasia in neonates

支气管肺发育不良(BPD)是新生儿,尤其是早产儿群体较为常见的慢性肺部疾病,对患儿的生存及远期生活质量均有重大影响。糖皮质激素是防治新生儿BPD的关键药物,但目前尚无明确统一的标准给药方案,需权衡各方案的疗效及可能产生的风险。本文对糖皮质激素药物品种的选择、用药时机的把握、不同给药途径及剂量选择对临床疗效和安全性的影响进行综述,从现有的循证医学证据中总结目前糖皮质激素治疗BPD的最佳治疗方案。目前证据表明,生后晚期静脉使用7~10 d中低剂量(<4 mg/kg)地塞米松是防治BPD疗效确切、安全性较高的方案。为了降低不良神经发育结局的风险,局部给药的方案(吸入用布地奈德,400~1000μg/d,疗程≥14 d)近年来正逐步兴起,可能与降低BPD发病率和死亡率相关,但其疗效和安全性仍需更大样本的随机临床试验来进一步验证。

Bronchopulmonary dysplasia(BPD)is common chronic lung disease in neonates,especially in premature infants,which has a significant impact on the survival and long-term quality of life of children.Glucocorticoids are the key drugs for the prevention and treatment of neonatal BPD,but there is no clear and unified standard administration regimen,and the efficacy and possible risks of each regimen need to be weighed.In this paper,the selection of glucocorticoid drug varieties,the timing of administration,the influence of different administration routes and dose selection on clinical efficacy and safety are reviewed,and the best treatment plan of glucocorticoid for BPD is summarized from the existing evidence-based medical evidence.Current evidence shows that intravenous Dexamethasone(<4 mg/kg)used in late postnatal period for 7-10 days is effective and safe for the prevention and treatment of BPD.To reduce the risk of adverse neurodevelopmental outcomes,local administration regiments(inhaled Budesonide,400 to 1000μg/d,duration≥14 days)have been emerging in recent years and may be associated with reduced BPD morbidity and mortality,but their efficacy and safety need to be further validated in larger randomized clinical trials.