糖皮质激素雾化吸入疗法 在支气管肺发育不良（BPD）中的应用,支气管肺发育不良（BPD）的定义,Greenough A, Premkumar M, Patel D. Ventilatory strategies for the extremely premature infant. Paediatr Anaesth. 2008;18(5):371-7.,BPD的病因和发病机制,常立文.新生儿支气管肺发育不良诊治进展. 临床儿科杂志.2007;25(3):161-165.,BPD的临床表现,常立文.新生儿支气管肺发育不良诊治进展. 临床儿科杂志.2007;25(3):161-165.,BPD的诊断标准和分度,常立文.新生儿支气管肺发育不良诊治进展. 临床儿科杂志.2007;25(3):161-165.,1.Ramanathan R. Optimal ventilatory strategies and surfactant to protect the preterm lungs. Neonatology. 2008;93(4):302-8,BPD的治疗原则,雾化吸入布地奈德混悬液治疗BPD的用法,雾化吸入剂量为0.52mg/d 疗程为1030d或更久,Nykanen P, Raivio T, Heinonen K, et al. Circulating glucocorticoid bioactivity and serum cortisol concentrations in premature infants: the influence of exogenous glucocorticoids and clinical factors. Eur J Endocrinol. 2007;156(5):577-83.,布地奈德混悬液预防BPD的疗效,a P0.05,布地奈德+表面活性剂组vs 表面活性剂组.括号显示需要通气的婴儿数,治疗后14天内MAP，FIO2,OI，PO2, PCO2和pH的变化,Yeh TF, et al.Early intratracheal instillation of budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants: a pilot study. Pediatrics. 2008;121(5):e1310-8.,布地奈德+表面活性剂更显著改善 早产儿的肺功能,*,*布地奈德表面活性剂组：气管内滴入0.25mg/Kg布地奈德和100.00mg/Kg 贝拉康坦的混合物 ，每8h一次,布地奈德+表面活性剂更显著增加 拔管患儿百分比,*布地奈德表面活性剂组：气管内滴入0.25mg/Kg布地奈德和100.00mg/Kg 贝拉康坦的混合物 ，每8h一次,Yeh TF, et al.Early intratracheal instillation of budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants: a pilot study. Pediatrics. 2008;121(5):e1310-8.,布地奈德+表面活性剂更显著减少 死亡或发展为慢性肺疾病的患儿比例,*布地奈德表面活性剂组：气管内滴入0.25mg/Kg布地奈德和100.00mg/Kg 贝拉康坦的混合物 ，每8h一次,Yeh TF, et al.Early intratracheal instillation of budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants: a pilot study. Pediatrics. 2008;121(5):e1310-8.,布地奈德+表面活性剂 更显著增加无慢性肺疾病的患儿比例,*布地奈德表面活性剂组：气管内滴入0.25mg/Kg布地奈德和100.00mg/Kg 贝拉康坦的混合物 ，每8h一次,Yeh TF, et al.Early intratracheal instillation of budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants: a pilot study. Pediatrics. 2008;121(5):e1310-8.,布地奈德+表面活性剂治疗对早产儿的影响,结论 这项先导性研究显示出生后早期以表面活性剂作为载体气管内滴入布地奈德可显著改善早产儿死亡或发展为慢性肺疾病的结果，并且不引起直接不良反应,Yeh TF, et al.Early intratracheal instillation of budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants: a pilot study. Pediatrics. 2008;121(5):e1310-8.,布地奈德+表面活性剂治疗 对早产儿的远期影响,Kuo HT, 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 Pediatr. 2010;156(4):537-41.,布地奈德+表面活性剂治疗 不影响早产儿体格发育,男孩,女孩,(cm),*,*布地奈德表面活性剂组：气管内滴入0.25mg/Kg布地奈德和100.00mg/Kg 贝拉康坦的混合物 ，每8h一次,(cm),Kuo HT, 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 Pediatr. 2010;156(4):537-41.,*数值为均数标准差,布地奈德+表面活性剂治疗 不影响早产儿神经和智力发育,Kuo HT, 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 Pediatr. 2010;156(4):537-41.,布地奈德+表面活性剂治疗 不影响早产儿神经和智力发育,*布地奈德表面活性剂组：气管内滴入0.25mg/Kg布地奈德和100.00mg/Kg 贝拉康坦的混合物 ，每8h一次,神经发育障碍发生率(%),布地奈德+表面活性剂组* （n=35),表面活性剂组 （n=32),P=0.367,布地奈德+表面活性剂治疗对早产儿的远期影响,结论 早期以表面活性剂作为载体气管内滴入布地奈德可显著改善早产儿肺功能，并且不引起长期不良反应,Kuo HT, 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 Pediatr. 2010;156(4):537-41.,Thank You!,