미숙아에서의 적정 산소요법
Optimal Oxygenation in Preterm Infants
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초록
수십년 간 산소는 미숙아치료에서 가장 많이 사용되어온 중요한 치료수단 중 하나였다. 치료 초기의 무분별한 산소치료로 미숙아망막증의 증가와 이후 오히려 과도한 제한으로 인한 사망률의 증가를 보였다. 이후 많은 연구와 임상경험을 통해 눈, 귀, 폐 등을 포함한 각종 장기에 미치는 여러 산소독성 또한 보고 되고 있다. 저산소증과 고산소증 모두가 미숙아에 해가 되므로 이러한 위험을 최소화 할 수 있는 적정 산소치료 기준이 요구되어 왔다. 최근 대규모 다국적 전향적 메타분석 연구에서는 28주 미만의 미숙아에서 저산소포화도군(85-89%)에서 높은 사망률과 괴사성장염을 보였고, 고산소포화도군(91-95%)에서는 높은 미숙아망막증이 발생한 결과를 얻었다. 아직 미숙아에서 적정 산소치료 기준은 명확하지 않은 상태이며 앞으로도 세분화되고 명확한 기준제시를 위해서는 많은 연구들이 필요하다
Abstract
In the past several decades, supplemental oxygen has been used more than anyother medical product in preterm infants. Early trials suggested that restrictingoxygen supplementation could reduce retinopathy of prematurity without any otherconsequences; however, when oxygen restriction was practiced widely, an increasein the neonatal mortality rate was observed. Subsequently, many studies have beenreported oxygen toxicity and stress in the eye, brain, lungs and other organs. Bothhypoxia and hyperoxia are harmful, requiring clinicians to maintain the oxygenlevel at an optimal middle range in premature infants to minimize the risks associatedwith either of the two extremes. Recently, the results of a multi-national,randomized, prospective, meta-analysis collaboration study shows low saturationtargets (85-89%) until 36 weeks postmenstrual age are associated with a higher incidenceof deaths and necrotizing enterocolitis, whereas higher saturation targets (91-95%) are associated with a higher incidence of retinopathy of prematurity in infantsof <28 weeks’ gestational age. The optimal oxygenation target level in preterminfants still remains unclear and randomized control trials are required for furtherinvestigation according to gestational age and conditions of preterm infants.
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