Risk factors for persistent pulmonary hypertension of the newborn.
Risk factors for persistent pulmonary hypertension of the newborn.
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DOI：
10.4103/2045-8932.94818
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发表时间：
2012-01
影响因子：
2.6
通讯作者：
Cornfield DN
中科院分区：
文献类型：
--
作者：
Delaney C;Cornfield DN
在子宫内，肺血流受到严格限制，氧合和通气通过胎盘循环发生。在呼吸空气的生命的最初几次呼吸中，围产期肺循环经历了一个戏剧性的转变，因为肺血流量增加了10倍，肺动脉血压在出生后24小时内下降了50%。随着胎盘循环的丧失，肺流量的增加使氧气能够进入血流。解释肺循环显著转变的生理机制包括气液界面的建立、肺的节律性扩张、切应力的增加和来自肺内皮的一氧化氮的加工。如果围产期肺循环不扩张，血液在卵圆孔未闭和动脉导管水平从肺分流，导致严重和持续的低氧血症，其特征是新生儿持续性肺动脉高压（PPHN），这是一种没有最佳有效预防或治疗策略的综合征。尽管在治疗方面取得了重大进展，但PPHN仍然是地球仪新生儿中心发病率和死亡率的主要原因。虽然有可能增加PPHN风险的相关因素的信息，但知识仍然不完整。剖腹产、高母体体重指数、母体使用阿司匹林、非甾体类抗炎药和母体糖尿病是与PPHN风险增加相关的因素。最近的数据表明，母亲使用5-羟色胺再摄取抑制剂可能是PPHN的另一个重要危险因素。
In utero, pulmonary blood flow is closely circumscribed and oxygenation and ventilation occur via the placental circulation. Within the first few breaths of air-breathing life, the perinatal pulmonary circulation undergoes a dramatic transition as pulmonary blood flow increases 10-fold and the pulmonary arterial blood pressure decreases by 50% within 24 hours of birth. With the loss of the placental circulation, the increase in pulmonary flow enables oxygen to enter the bloodstream. The physiologic mechanisms that account for the remarkable transition of the pulmonary circulation include establishment of an air-liquid interface, rhythmic distention of the lung, an increase in shear stress and elaboration of nitric oxide from the pulmonary endothelium. If the perinatal pulmonary circulation does not dilate, blood is shunted away from the lungs at the level of the patent foramen ovale and the ductus arteriosus leading to the profound and unremitting hypoxemia that characterizes persistent pulmonary hypertension of the newborn (PPHN), a syndrome without either optimally effective preventative or treatment strategies. Despite significant advances in treatment, PPHN remains a major cause of morbidity and mortality in neonatal centers across the globe. While there is information surrounding factors that might increase the risk of PPHN, knowledge remains incomplete. Cesarean section delivery, high maternal body mass index, maternal use of aspirin, nonsteroidal anti-inflammatory agents and maternal diabetes mellitus are among the factors associated with an increased risk for PPHN. Recent data suggest that maternal use of serotonin reuptake inhibitors might represent another important risk factor for PPHN.