SUDDEN-INFANT-DEATH-SYNDROME - 1987 PERSPECTIVE
SUDDEN-INFANT-DEATH-SYNDROME - 1987 PERSPECTIVE
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DOI：
10.1016/s0022-3476(87)80001-x
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发表时间：
1987-05-01
影响因子：
5.1
通讯作者：
BROUILLETTE, RT
中科院分区：
文献类型：
--
作者：
HUNT, CE;BROUILLETTE, RT
SIDS 的病理生理学仍然未知。尽管根据现有数据，多因素原因似乎是合理的，但需要新数据来确定该多因素假设的哪些组成部分最重要，以及是否需要添加其他因素。我们需要更好地了解新生儿的呼吸控制以及婴儿期心肺控制成熟的方式。 SIDS 的独特脆弱期（即新生儿的风险低于 2 至 6 个月大时）仍无法解释。注定死于 SIDS 的婴儿的心肺控制的某些方面是否会恶化？尽管仅占所有 SIDS 死亡的一小部分，但更好地了解黑人婴儿、早产儿和宫内药物暴露婴儿的风险增加，应该会对我们的理解做出重大贡献。需要对处于危险中的无症状婴儿进行适当设计和良好对照的前瞻性研究，以确定当前 SIDS 的真实非干预率以及任何评估或干预降低该比率的程度。前瞻性呼吸图筛查研究表明，与后来的 SIDS 受害者相比，正常婴儿的呼吸模式存在显着的群体差异，但未能达到足够的敏感性和特异性，无法用于全人群的前瞻性筛查。除了传统呼吸图评估之外，为了评估脑干心肺控制的各个方面，未来的研究将需要基于扩展或改进的技术。基于生理考虑和现有技术，添加氧饱和度通道最有希望提供更全面的心肺控制评估。如果窒息觉醒反应性存在潜在缺陷，例如，有或没有其他呼吸控制缺陷，作为第二代呼吸图系统一部分的氧饱和度连续监测目前最有希望提供更广泛临床应用的改良呼吸图评估。还应该研究使用连续氧饱和度作为家庭监测技术。心肺变异的功率谱分析似乎也比传统的呼吸图分析具有潜在优势，需要在前瞻性研究中进行评估。以下陈述总结了我们目前有关 SIDS、呼吸暂停、呼吸图和家庭监护仪的知识： 1. SIDS 的原因仍然未知。 2. 关于 SIDS 的呼吸控制假说似乎仍然是最引人注目的，但将呼吸暂停视为呼吸控制的唯一或最重要组成部分是不正确的。 3. 没有前瞻性评估具有足够的敏感性和特异性来识别注定死于 SIDS 的婴儿。然而，呼吸描记图作为无症状婴儿筛查测试的失败并不等同于作为婴儿呼吸暂停有用测试的失败。 4. 所有婴儿期呼吸暂停患者都需要干预，呼吸检查可能有助于管理这些患者。 5. 目前婴儿期呼吸暂停患者后续 SIDS 的发生率较低，这可能至少部分归功于干预措施的有效性，而不是反驳 SIDS 与婴儿期呼吸暂停之间关系的证据。 6. 对于处于危险中的无症状婴儿，有关呼吸图和家庭监护仪的争议仍将悬而未决，直到使用改良或扩展的心肺分析和家庭监护技术进行适当设计的前瞻性对照研究。
The pathophysiology of SIDS remains unknown. Although a multifactorial cause appears plausible on the basis of available data, new data are needed to determine which components of this multifactorial hypothesis are most important and whether other factors need to be added. We need to better understand control of breathing in the newborn infant and the manner in which maturation of cardiorespiratory control progresses during infancy. The unique period of vulnerability for SIDS, in which risk is less in the neonate than at 2 to 6 months of age, remains unexplained. Is there a worsening in some aspect of cardiorespiratory control in infants destined to die of SIDS? An improved understanding of the increased risk in black infants, preterm infants, and infants with intrauterine drug exposure, although only a small percentage of all SIDS deaths, should contribute substantially to our understanding. Appropriately designed and well-controlled prospective studies are needed in asymptomatic infants at risk, to determine the true contemporary nonintervention rate of SIDS and the extent to which any assessment or intervention lowers this rate. Prospective pneumogram screening studies have demonstrated significant group differences in respiratory patterns in normal infants compared with later SIDS victims, but have failed to achieve sufficient sensitivity and specificity to be useful for populationwide prospective screening. To assess aspects of brainstem cardiorespiratory control in addition to those assessed by a conventional pneumogram, future studies will need to be based on an expanded or modified technology. On the basis of both physiologic considerations and available technology, addition of an oxygen saturation channel offers the most promise for providing a more comprehensive assessment of cardiorespiratory control. If there is an underlying deficiency in asphyxic arousal responsiveness, for example, with or without other respiratory control deficits, continuous monitoring of oxygen saturation as part of a second-generation pneumogram system currently has the greatest promise for providing a modified pneumogram assessment of greater clinical use. The use of continuous oxygen saturation as a home monitoring technique should also be investigated. Power spectrum analysis of cardiorespiratory variability also appears to have potential advantages over conventional pneumogram analyses, and needs to be evaluated in prospective studies. The following statements summarize our current knowledge regarding SIDS, apnea, pneumograms, and home monitors: 1. The cause(s) of SIDS remains unknown. 2. The respiratory control hypothesis regarding SIDS still appears to be the most compelling, but it is incorrect to consider apnea as either the only or the most important component of respiratory control. 3. No prospective assessment has sufficient sensitivity and specificity to identify infants destined to die of SIDS. However, failure of the pneumogram as a screening test in asymptomatic infants is not equivalent to failure as a useful test in apnea of infancy. 4. All patients with apnea of infancy require intervention, and pneumograms may be helpful in managing those patients. 5. The current low incidence of subsequent SIDS in patients with apnea of infancy may be a tribute, at least in part, to the efficacy of intervention, not proof against the relationship between SIDS and apnea of infancy. 6. In asymptomatic infants at risk, the controversy regarding pneumograms and home monitors will remain unresolved until appropriately designed prospective controlled studies have been conducted using a modified or expanded technology for cardiorespiratory analysis and for home monitoring.