Prevention of bronchopulmonary dysplasia.
Prevention of bronchopulmonary dysplasia.
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DOI：
10.1016/j.siny.2009.08.002
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发表时间：
2009-12
影响因子：
3
通讯作者：
Bose, Carl
中科院分区：
文献类型：
--
作者：
Laughon, Matthew M.;Smith, P. Brian;Bose, Carl
在制定减少慢性肺部疾病发病率的战略方面做出了相当大的努力，包括使用药物、营养疗法和呼吸护理做法。不幸的是，这些策略中的大多数都没有成功。到目前为止，仅有两种专门开发的预防CLD的治疗方法的有效性得到了随机对照试验证据的支持，这两种治疗方法是静脉注射维生素A和皮质类固醇。另外两种治疗方法--使用咖啡因治疗早产儿呼吸暂停和积极光疗法治疗高胆红素血症--被评估为改善其他结果，并发现可以减少CLD。队列研究表明，使用CPAP作为避免机械通气的策略也可能是有益的。其他疗法可以减少动物模型中的肺损伤，但似乎不能减少人类的慢性肺病。这些有效疗法的益处不大，绝对风险降低在7%-11%之间。需要采取进一步的预防战略来减轻这一疾病的负担。然而，每种疗法都需要在随机对照试验中进行测试，新疗法的预期应该是适度降低疾病的发病率。
Considerable effort has been devoted to the development of strategies to reduce the incidence of chronic lung disease, including use of medications, nutritional therapies, and respiratory care practices. Unfortunately, most of these strategies have not been successful. To date, the only two treatments developed specifically to prevent CLD whose efficacy is supported by evidence from randomized, controlled trials are the parenteral administration of vitamin A and corticosteroids. Two other therapies, the use of caffeine for the treatment of apnea of prematurity and aggressive phototherapy for the treatment of hyperbilirubinemia were evaluated for the improvement of other outcomes and found to reduce CLD. Cohort studies suggest that the use of CPAP as a strategy for avoiding mechanical ventilation might also be beneficial. Other therapies reduce lung injury in animal models but do not appear to reduce CLD in humans. The benefits of the efficacious therapies have been modest, with an absolute risk reduction in the 7–11% range. Further preventive strategies are needed to reduce the burden of this disease. However, each will need to be tested in randomized, controlled trials, and the expectations of new therapies should be modest reductions of the incidence of the disease.
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