早产儿支气管肺发育不良防治环节中早期呼吸支持的策略

虽然呼吸窘迫综合征( RDS)仍然是导致极早和超早早产儿呼吸衰竭最常见疾病,但由于NICU呼吸技术的进步,其已经不再是死亡的主要病因。伴随着 RDS的发生,支气管肺发育不良( BPD)这一成熟依赖性肺疾病的发生和发展成为现代NICU防治的核心疾病之一。在早期呼吸支持策略环节中有以下共识与建议：(1)最大可能的使具有高风险RDS或RDS的极早和超早早产儿期避免气管插管,接受无创通气(nCPAP)；(2)早期选择合适的方式接受肺表面活性物质(PS)治疗；(3)个体化的制定nCPAP或其他无创通气失败的标准,尽早接受PS救治和适宜的有创通气模式；(4)缩短通气时间,应用无创通气方式辅以咖啡因治疗降低拔管失败率。这些临床研究成果仍需要不断在实践中改进与完善,BPD的发生是多因素作用的结果,需要多维度的管理的进步才能真正实现有效的防治。

Early respiratory support for very preterm infant to prevent bronchopulmonary dysplasia

Although respiratory distress syndrome( RDS) ,one of the most common cause of respira-tory failure in the very or extremely preterm infant,has not been yet the major disorder of death with advances of respiratory support;In fact,RDS often complicated with BPD which developed with the maturation of de-pendence,the outcome of BPD and its development step into the focus of modern NICU. Powerful evidence-based consensus and suggestions have been stated in early respiratory support for very and extremely preterm infant:Early nasal CPAP( nCPAP) should be the best alternative to intubation for very or extremely preterm infant with high-risk of RDS and RDS; Early administration of Pulmonary surfactant ( PS ) with suitable methods( InSurE,Intubation Surfactant Extubation or LISA,Less invasive surfactant administration);Individ-ual threshould for nCPAP or other noninvasive ventilation failure should be established,but early PS adminis-tration and gentle ventilation will decrease the incidence of ventilator-induced injury on failuring noninvasive ventilation;Noninvasive ventilation with the use of caffeine will short the duration of ventilation and improve the success of weaning off. All the strategies in respiratory support to prevent BPD for very preterm infant still need more practice sustain improvement since multiple causes account for the development of BPD.