Bronchopulmonary Dysplasia: Then and Now
Bronchopulmonary Dysplasia: Then and Now
复制标题
DOI：
10.1159/000336030
复制
发表时间：
2012-01-01
期刊：
影响因子：
2.5
通讯作者：
Philip, Alistair G. S.
中科院分区：
文献类型：
--
作者：
Philip, Alistair G. S.
当支气管肺发育不良 (BPD) 于 1967 年首次被描述时，新生儿辅助通气的使用还处于起步阶段。与高浓度氧气有关，BPD 等同于“肺氧中毒”。 20 世纪 70 年代，不仅强调了氧气的病因作用，还强调了吸气峰值压力以及两者接触的持续时间，但 BPD 仍然是 20 世纪 80 年代治疗呼吸窘迫综合征的可怕并发症。直到外源性表面活性剂商业化用于气管内给药后，“经典”BPD 才开始消失，并被“新”BPD 取代。 “经典”BPD 见于较成熟的早产儿（胎龄 1-28 周），其严重形式的放射学特征为肺部微囊肿和大囊肿、肺部过度充气和膈肌扁平。相比之下，“新的”BPD 见于不太成熟的婴儿（胎龄！28 周），具有相对轻微的放射学异常，并被定义为在月经后 36 周时持续需氧。从病理学角度来看，“经典”BPD 经常显示阻塞性细支气管炎和肺实质纤维化，而“新”BPD 则表现出最小的纤维化，但发展一致停滞。本文描述了可能导致 BPD 病因的因素，以及可能的预防和治疗策略。版权所有 (C) 2012 S. Karger AG，巴塞尔
When bronchopulmonary dysplasia (BPD) was first described in 1967, the use of assisted ventilation in neonates was in its infancy. High concentrations of oxygen were implicated, and BPD was equated with 'pulmonary oxygen toxicity'. The etiologic role of not only oxygen but also peak inspiratory pressures and the duration of exposure to both was emphasized in the 1970s, but BPD remained a dreaded complication of managing respiratory distress syndrome in the 1980s. It was only after exogenous surfactant became commercially available for endotracheal administration that 'classical' BPD began to disappear and was replaced by the 'new' BPD. 'Classical' BPD was seen in more mature preterm infants (1 28 weeks' gestational age) and in its severe form was characterized radiographically by micro- and macrocysts of the lung, lung hyperinflation and flattening of the diaphragms. In contrast, 'new' BPD is seen in less mature infants (! 28 weeks' gestational age), has comparatively mild radiographic abnormalities and has been defined as continued oxygen requirement at 36 weeks' postmenstrual age. Pathologically, 'classical' BPD frequently revealed obstructive bronchiolitis and fibrosis of lung parenchyma, whereas 'new' BPD demonstrates minimal fibrosis but uniform arrest of development. Herein, factors which may contribute to the etiology of BPD are described, as well as possible preventative and therapeutic strategies. Copyright (C) 2012 S. Karger AG, Basel