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尽管RDS在围产期的治疗有最新的进展,但仍然存在争议。欧洲新生儿专家组对2007年指南进行审视,并根据2009年以来出版的文献,对新生儿呼吸窘迫综合征(NRDS)治疗指南进行修订,强有力的证据显示:产前给予一剂糖皮质激素对预防NRDS有肯定效果,但潜在的副作用和重复治疗的安全性尚不清楚。对于刚出生且病情稳定的早产儿处理包括:(1)氧疗、正压通气的效果尚缺乏证据,这些处理甚至可能有害;(2)肺表面活性物质替代治疗对于处理NRDS至关重要,但药物的选择、理想的剂量和不同孕期应用时机尚不清楚;(3)机械通气可能会挽救生命,但同样会造成肺部损伤,提出尽量应用鼻塞正压通气,减少或避免机械通气。为使NRDS患儿有较好的转归,有必要提供最佳的支持护理,包括维持正常体温、给予适当液体、良好的营养支持、处理动脉导管未闭和循环支持以保持足够的血压。
Despite the recent advances in perinatal treatment of RDS, there is still controversy. The European Neonatology Panel reviewed the 2007 guidelines and revised guidelines for the treatment of neonatal respiratory distress syndrome (NRDS) on the basis of published literature since 2009, with strong evidence that prenatal administration of a single dose of glucocorticoid There is a positive effect in preventing NRDS, but the potential side effects and the safety of repeated treatment are not yet clear. Treatment of newborn infants with stable conditions includes: (1) Oxygen therapy and positive pressure ventilation are lacking in evidence of effectiveness and may even be detrimental; (2) Surfactant replacement therapy is of paramount importance for the management of NRDS The choice of drug, the ideal dose and the timing of application in different pregnancies is unclear. (3) Mechanical ventilation may save lives, but it also causes lung damage. It is suggested that nasal positive pressure ventilation should be applied as much as possible to reduce or avoid mechanical ventilation. In order to make a better outcome for children with NRDS, it is necessary to provide the best supportive care, including maintaining normal body temperature, giving proper fluid, good nutritional support, handling patent ductus arteriosus and circulation support to maintain adequate blood pressure.