吸入性糖皮质激素防治早产儿BPD的研究进展
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摘要
随着新生儿救治水平的不断发展,低出生体重儿的存活率不断提高,随之而来,支气管肺发育不良(BPD)的发病率也逐年上升。BPD对早产儿的生存及生活质量产生了严重影响。静脉应用糖皮质激素可以防治BPD,但因同时会增加近期及晚期并发症,甚至发生脑瘫等不良结局,而不被推荐为预防BPD的常规使用。近年来有研究表明,局部应用吸入性糖皮质激素在预防早产儿BPD中,不仅与静脉应用糖皮质激素具有相似的疗效作用,同时避免了神经不良结局的副作用,特别是将肺表面活性物质(PS)作为载体,早期联合应用布地奈德气管内滴入,对预防早产儿BPD具有一定的应用前景。
With the continuous development of the level of neonatal treatment,the survival rate of low birth weight infants is increasing,consequently,the incidence of bronchialpulmonary dysplasia( BPD) also rose. BPD has a serious effect on the survival and quality of life of premature infants. General application of glucocorticoid can prevent and treat bronchopulmonary dysplasia,but it is not recommended for routine use because it will increase the incidence of adverse reactions such as recent complications,late complications and even cerebral palsy. In recent years,studies have shown that topical application of inhaled corticosteroids in the prevention of premature babies BPD may play a very important role,Compared with systemic corticosteroids,inhaled corticosteroids were similar for preventing BPD,At the same time,the side effects of neurodevelopmental impairment were avoided,especially instillation of budesonide using surfactant as a vehicle,has a certain ap-plication prospecton the prevention of BPD.
With the continuous development of the level of neonatal treatment,the survival rate of low birth weight infants is increasing,consequently,the incidence of bronchialpulmonary dysplasia( BPD) also rose. BPD has a serious effect on the survival and quality of life of premature infants. General application of glucocorticoid can prevent and treat bronchopulmonary dysplasia,but it is not recommended for routine use because it will increase the incidence of adverse reactions such as recent complications,late complications and even cerebral palsy. In recent years,studies have shown that topical application of inhaled corticosteroids in the prevention of premature babies BPD may play a very important role,Compared with systemic corticosteroids,inhaled corticosteroids were similar for preventing BPD,At the same time,the side effects of neurodevelopmental impairment were avoided,especially instillation of budesonide using surfactant as a vehicle,has a certain ap-plication prospecton the prevention of BPD.
引文
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[15]黄智峰,李欢,黄鹏,等.早期雾化吸人布地奈德预防极低出生体质量儿支气管肺发育不良[J].中华实用临床儿科杂志,2018,33(2):117-119.
[16] Onland W,Offringa M,Van K A. Late(≥7 days)inhalation cor Iicosteroids to reduce bronchopulmonarydysplasiainpreterminfants[J]. cochrane Database Syst Rev,2012,(4):CD002311.
[17] Shah V,Ohlsson A,Halliday HL,et al. Early administration of inhaled corticostemids for preventing chronic lung disease in ventilated very low birth weight preterm neonates[J]. Cochrane Datahase Syst Rev,2012,16(5):CD001969.
[18]申昆玲,邓力,李云珠,等.糖皮质激素雾化吸入疗法在儿科应用的专家共识[M].临床儿科杂志,2018,36(2):95-106.
[19] Yeh TF,Chen CM,Wu SY,et al. Intratracheal administration of budesonide/surfactant to prevent bronchopulmonary dysplasia[J]. Am J Respir Crit Care Med,2016,193(1):86-95.
[20] Meltzer EO,Pearlman DS,Eckerwall G,et al. Efficacy and safety of budesonide administered by pressurized metereddose inhaler in children with asthma[J]. Ann Allerqy Asthma Immunol,2015,115(6):516-522.
[21] Nimmo AJ,Carstairs JR,Patole SK,et al. Intratracheal administration of glucocorticoids using surfactant as a vehicle[J]. Clin Exp Pharmacol Physiol,2002,29:661-665.
[22] Yeh TF,Lin HC,Chang CH,et al. Early intratracheal instillation of budesonie using surfactant as a vehicle to prevent chronic lung disease in preterm infants:a Polit study[J]. Pediatrics,2008,12l(5):e1310-1318.
[23] Kuo HT,Lin HC,Tsai CH,et al. A follow-up study of preterm infants given budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants[J]. J Pediatr,2010,156(4):537-541.
[24] Ke H,Li ZK,Yu XP,et al. Efficacy of different preparations of budesonidecombined with pulmonarysurfactant in the treatment of neonatal respiratory distress syndrome:a comparative analysis[J].Zhongguo Dang Dai Er Ke Za Zhi,2016,18(5):400-404.
[25] Venkataraman R,Kamaluddeen M,Hasan SU,et al. Intratracheal administration of budesonide-surfactant in prevention of bronchopulmonary dysplasia in very low birth weight infants:A systematic review and Meta-analysis[J]. Pediatr Pulmonol,2017,52(7):968-975.
[26]陈奕江,张水堂,杨润娜等生后7天内气道内应用布地奈德对早产儿支气管肺发育不良发生率影响的系统评价和Meta分析[J].中国循证儿科杂志,2016,8(11):259-263.
[2] Mc Evoy CT,Jain L,Schmidt B,et al. Bronchopulmonary dysplasia:NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases[J]. Ann Am Thorac Soc 2014,11(suppl 3):S146-S153.
[3] Beam KS,Aliaga S,Ahlfeld SK,et al. A systematic review of randomized controlled trials for the prevention of bronchopulmonary dysplasia in infants[J]. J Perinatol 2014,34:705-710.
[4] Dolovich MB,Ahrens RC,Hess DR,etal. Device selection and outcomes of aerosol therapy:evidence-basedguidelines:American College of Chest Physicians/American College of Asthma,Allergy,and Immunology[J]. Chest,2005,127(1):335-371.
[5] Mendes ES,Rebolledo P,Campos M,et al. Immediate antiinflammatory effects of inhaled budesonide in patients with asthma[J].Ann Am Thorac Soc. 2014,11(5):706-711.
[6] Sun J,Zhang P,Zhang B,et al. Budesonide ameliorates lung function of the cigarette smoke-exposed rats through reducing matrix metalloproteinase-1 content[J]. Int J Clin Exp Pathol. 2015,8:5137-5144.
[7] Yang CF,Lin CH,Chiou SY,et al. Intratracheal budesonide supplementation in addition to surfactant improves pulmonary outcome in surfactant-depleted newborn piglets[J]. Pediatr Pulmonol,2013,48(2):151-159.
[8] Yu ZW,Zhang JH. Effect of inhaled budesonide on surfactant protein expression in asthmatic mice[J]. Allergy Asthma Proc. 2008,29:486-492.
[9]申昆玲,邓力,李云珠,等.糖皮质激素雾化吸入疗法在儿科应用的专家共识[M].临床儿科杂志,2014,32(6):504-511.
[10] Slaughter JL,Stenger MR,Reagan PB,et al. Utilization of inhaled corticosteroids for infants with bronchopulmonary dysplasia[J].PLo S One,2014,9(9):e106838.
[11] Maas C,Poets CF,Bassler D. Survey of practices regarding utilization of inhaled steroids in 223 German neonatal units[J]. Neonatology,2010,98(4):404-408.
[12] Zhang ZQ,Zhong Y,Huang XM,et al. Airway administration of corticosteroids for prevention of bronchopulmonary dysplasia in premature infants:a meta-analysis with trial sequential analysis[J]. BMC Pulm Med,2017,17,207.
[13] Bassler D,Plavka R,Shinwell Es,et al. Early inha Ied budesonide for the prevention of bronchopulmonary dysplasia[J]. N Engl J Med,2015,373(16):1497-l506.
[14] Bassler D,Shinwell ES,Hallman M,etal,Long-Term Effects of Inhaled Budesonidefor? Bronchopulmonary Dysplasia[J]. N Engl J Med. 2018,378(2):148-157.
[15]黄智峰,李欢,黄鹏,等.早期雾化吸人布地奈德预防极低出生体质量儿支气管肺发育不良[J].中华实用临床儿科杂志,2018,33(2):117-119.
[16] Onland W,Offringa M,Van K A. Late(≥7 days)inhalation cor Iicosteroids to reduce bronchopulmonarydysplasiainpreterminfants[J]. cochrane Database Syst Rev,2012,(4):CD002311.
[17] Shah V,Ohlsson A,Halliday HL,et al. Early administration of inhaled corticostemids for preventing chronic lung disease in ventilated very low birth weight preterm neonates[J]. Cochrane Datahase Syst Rev,2012,16(5):CD001969.
[18]申昆玲,邓力,李云珠,等.糖皮质激素雾化吸入疗法在儿科应用的专家共识[M].临床儿科杂志,2018,36(2):95-106.
[19] Yeh TF,Chen CM,Wu SY,et al. Intratracheal administration of budesonide/surfactant to prevent bronchopulmonary dysplasia[J]. Am J Respir Crit Care Med,2016,193(1):86-95.
[20] Meltzer EO,Pearlman DS,Eckerwall G,et al. Efficacy and safety of budesonide administered by pressurized metereddose inhaler in children with asthma[J]. Ann Allerqy Asthma Immunol,2015,115(6):516-522.
[21] Nimmo AJ,Carstairs JR,Patole SK,et al. Intratracheal administration of glucocorticoids using surfactant as a vehicle[J]. Clin Exp Pharmacol Physiol,2002,29:661-665.
[22] Yeh TF,Lin HC,Chang CH,et al. Early intratracheal instillation of budesonie using surfactant as a vehicle to prevent chronic lung disease in preterm infants:a Polit study[J]. Pediatrics,2008,12l(5):e1310-1318.
[23] Kuo HT,Lin HC,Tsai CH,et al. A follow-up study of preterm infants given budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants[J]. J Pediatr,2010,156(4):537-541.
[24] Ke H,Li ZK,Yu XP,et al. Efficacy of different preparations of budesonidecombined with pulmonarysurfactant in the treatment of neonatal respiratory distress syndrome:a comparative analysis[J].Zhongguo Dang Dai Er Ke Za Zhi,2016,18(5):400-404.
[25] Venkataraman R,Kamaluddeen M,Hasan SU,et al. Intratracheal administration of budesonide-surfactant in prevention of bronchopulmonary dysplasia in very low birth weight infants:A systematic review and Meta-analysis[J]. Pediatr Pulmonol,2017,52(7):968-975.
[26]陈奕江,张水堂,杨润娜等生后7天内气道内应用布地奈德对早产儿支气管肺发育不良发生率影响的系统评价和Meta分析[J].中国循证儿科杂志,2016,8(11):259-263.