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

Abstract

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

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

Figures/Tables 3

References 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

Concerns about diagnosis and treatment of bronchopulmonary dysplasia

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