支气管肺发育不良诊断及治疗中几个关注问题

doi:10.12372/jcp.2022.22e0333

临床儿科杂志 ›› 2022, Vol. 40 ›› Issue (6): 413-419.doi: 10.12372/jcp.2022.22e0333

支气管肺发育不良诊断及治疗中几个关注问题

李芳, 刘立婷

重庆医科大学附属儿童医院新生儿科国家儿童健康与疾病临床医学研究中心儿童发育疾病研究教育部重点实验室儿科学重庆市重点实验室（重庆 400014）

收稿日期:2022-03-08 出版日期:2022-06-15 发布日期:2022-06-07
作者简介:李芳（1979年—）,博士, ORCID：0000-0001-9038-4877, 青年编委,儿科学博士,主任医师,硕士研究生导师。重庆医科大学附属儿童医院院办公室副主任,荣获“重庆市中青年医学高端人才”称号,现任中国医师协会新生儿科医师分会生命支持专委会副主任委员,中华医学会围产医学专委会产房安全与助产学组委员,重庆医学会围产医学专委会委员兼秘书等学术任职。获得重庆医科大学优秀博士论文,先后在丹麦哥本哈根大学和美国奥古斯塔大学儿童医学中心担任访问学者,主持和主研国家自然科学基金4项,主持省市级课题4项,以第一作者或通讯作者发表SCI论文8篇,获得实用新型专利4项,执笔制定专家共识2篇,获得重庆市医学会进步二等奖1项,中国妇幼健康科学技术三等奖1项,参编专著3部,培养硕士研究生5名,参与培养博士研究生2名。
基金资助:
重庆市自然科学基金(cstc2021jcyj-msxmX0257);重庆市科卫联合项目(2021MSXM202)

Concerns about diagnosis and treatment of bronchopulmonary dysplasia

LI Fang, LIU Liting

Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China

Received:2022-03-08 Online:2022-06-15 Published:2022-06-07

摘要/Abstract

摘要：

支气管肺发育不良（BPD）是早产儿尤其是极低出生体质量儿和超低出生体质量儿中最常见的慢性肺部疾病,严重影响患儿的生存和生活质量。目前,BPD发病率仍居高不下。随着对BPD认识的深入,BPD的诊断标准不断修正,治疗方法不断改进和完善,但BPD诊断标准的选择、治疗中的呼吸支持模式的选择和糖皮质激素的使用仍是临床医师存在困惑和关注的问题。本文在回顾了不同时期的BPD的诊断标准,比较它们各自的优点和不足,并针对BPD患儿的呼吸支持管理及糖皮质激素防治BPD中的关注问题进行讨论和展望。

关键词: 支气管肺发育不良, 诊断标准, 呼吸支持, 糖皮质激素

Abstract:

Bronchopulmonary dysplasia (BPD) is the commonest chronic lung disease in premature infants, especially in very and extremely low birth weight infant. BPD affects the survival rate and the quality of life of premature infants. At present, the incidence of BPD remains high. With the in-depth understanding of BPD, the diagnostic criteria of BPD are constantly revised, and the treatment methods are constantly improved and perfected. However, the selection of diagnostic criteria for BPD, the selection of respiratory support mode in treatment and the use of glucocorticoids are still problems that clinicians are confused and concerned about. This manuscript compared the different diagnostic criteria of BPD, which are all commonly used in the last decade. In addition, we discussed respiratory support management and glucocorticoid use in the prevention and treatment of BPD in neonates.

Key words: bronchopulmonary dysplasia, diagnostic criteria, respiratory support, glucocorticoids

李芳, 刘立婷. 支气管肺发育不良诊断及治疗中几个关注问题[J]. 临床儿科杂志, 2022, 40(6): 413-419.

LI Fang, LIU Liting. Concerns about diagnosis and treatment of bronchopulmonary dysplasia[J]. Journal of Clinical Pediatrics, 2022, 40(6): 413-419.

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参考文献 36

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标准	诊断时机	影像学评估	分级评估时机	分级依据
2001 NICHD	任何氧依赖（FiO₂>21%）>28 d	无	胎龄<32周,PMA 36周或出院时;胎龄≥32周,生后56 d或出院时	FiO₂
2018 NICHD	胎龄<32周, PMA 36周时持续用氧≥3 d	肺实质病变	PMA 36周	FiO₂、呼吸支持模式
2019 Jensen	PMA 36周时持续用氧	无	PMA 36周	呼吸支持模式

标准	分级依据	无BPD	轻度/ I级	中度/ II级	重度/ III级
2001 NICHD	FiO₂及是否正压通气	-	未用氧	FiO₂<30%	FiO₂≥30%或需正压通气
2018 NICHD¹⁾	有创正压通气	-	无	FiO₂ 21%	FiO₂>21%
	NCPAP、NIPPV或流量≥3L/min的鼻导管	-	FiO₂ 21%	FiO₂ 22%~29%	FiO₂≥30%
	流量1~3L/min的鼻导管或头罩吸氧	-	FiO₂ 22%~29%	FiO₂≥30%	鼻导管及头罩吸氧均不考虑Ⅲ级
	流量<1L/min的鼻导管	-	FiO₂ 22%~70%	FiO₂>70%	鼻导管及头罩吸氧均不考虑Ⅲ级
2019 Jensen	呼吸支持模式	未吸氧	鼻导管吸氧<2L/min	鼻导管吸氧>2L/min或无创通气	有创机械通气

糖皮质激素	使用方式	剂量	使用时机
糖皮质激素	使用方式	剂量	<7 d	7~14 d	15~21 d	>21 d
地塞米松	静脉	小剂量	不推荐	机械通气1~2周仍不能撤机的BPD高风险早产儿可选择短疗程低剂量DART方案,早期使用效果更佳,1个疗程DART方案效果欠佳的可使用第2疗程		晚期使用DART方案早产儿发生II级或III级BPD的风险可能更高
地塞米松	静脉	大剂量	不推荐	不推荐	不推荐	不推荐
氢化可的松	静脉	小剂量	小于28周和/或有绒毛膜羊膜炎病史BPD高风险早产儿可选择10 d低剂量疗程用以预防BPD	不推荐	不推荐	不推荐
氢化可的松	静脉	大剂量	不推荐	不推荐	不推荐	不推荐
糖皮质激素	吸入	不推荐

支气管肺发育不良诊断及治疗中几个关注问题

Concerns about diagnosis and treatment of bronchopulmonary dysplasia

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