Neonatal Medicine

  • 제16권2호
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  • Pages.146-153
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  • 2009
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  • 2287-9412(pISSN)
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  • 2287-9803(eISSN)
대한신생아학회 (The Korean Society of Neonatology)
권호 표지

기관지폐 이형성증에 대한 덱사메타손 구제 치료

Current Use of Dexamethasone Rescue Therapy for Bronchopulmonary Dysplasia

  • 정의석 (서울대학교 의과대학 소아과학교실) ;
  • 안요한 (서울대학교 의과대학 소아과학교실) ;
  • 이주영 (서울대학교 의과대학 소아과학교실) ;
  • 김윤주 (서울대학교 의과대학 소아과학교실) ;
  • 손세형 (서울대학교 의과대학 소아과학교실) ;
  • 손진아 (서울대학교 의과대학 소아과학교실) ;
  • 이은희 (서울대학교 의과대학 소아과학교실) ;
  • 최은진 (서울대학교 의과대학 소아과학교실) ;
  • 김은선 (서울대학교 의과대학 소아과학교실) ;
  • 이현주 (서울대학교 의과대학 소아과학교실) ;
  • 이진아 (서울대학교 의과대학 소아과학교실) ;
  • 최창원 (서울대학교 의과대학 소아과학교실) ;
  • 김이경 (서울대학교 의과대학 소아과학교실) ;
  • 김한석 (서울대학교 의과대학 소아과학교실) ;
  • 김병일 (서울대학교 의과대학 소아과학교실) ;
  • 최중환 (서울대학교 의과대학 소아과학교실)
  • Jung, Eui-Seok (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University) ;
  • Ahn, Yo-Han (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University) ;
  • Lee, Ju-Young (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University) ;
  • Kim, Yoon-Joo (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University) ;
  • Son, Se-Hyung (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University) ;
  • Sohn, Jin-A (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University) ;
  • Lee, Eun-Hee (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University) ;
  • Choi, Eun-Jin (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University) ;
  • Kim, Eun-Sun (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University) ;
  • Lee, Hyun-Ju (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University) ;
  • Lee, Jin-A (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University) ;
  • Choi, Chang-Won (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University) ;
  • Kim, Ee-Kyung (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University) ;
  • Kim, Han-Suk (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University) ;
  • Kim, Beyong-Il (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University) ;
  • Choi, Jung-Hwan (Division of Neonatology, Department of Pediatrics, College of Medicine Seoul National University)
  • 발행 : 2009.11.30

⟨ 이전 논문 다음 논문 ⟩

초록

목 적: 고식적인 치료에 반응하지 않는 기관지폐 이형성증에 대한 치료로서 덱사메타손 구제 치료의 사용현황을 조사하기 위해 본 연구를 시행하였다. 방 법: 2004년 3월부터 2008년 8월까지 서울대학교 어린이병원 및 분당서울대학교병원 신생아 중환자실에 입원하여 기관지폐 이형성증으로 치료를 받은 251례의 미숙아를 대상으로 후향적으로 연구하였다. 산모와 신생아들의 인구학적, 임상적 특성을 살펴보았으며, 덱사메타손 구제 치료의 반응성에 따라 반응군 및 비반응군간의 차이점을 비교 분석하였다. 또한 덱사메타손 구제 치료에 따른 합병증을 조사하였다. 결 과: 93례(37.1%)가 중증도의 기관지폐 이형성증으로 분류되었으며, 모든 덱사메타손 구제 치료는 중증도의 기관지폐 이형성증을 가진 사례에서 시행되었다. 덱사메타손은 고식적인 치료가 실패하여 기관 발관이 불가능한 호흡 곤란을 가진 24례(9.6%)에서 투여되었다. 투여된 사례 중 14례(58.3%)에서 덱사메타손 구제 치료에 반응을 나타냈다. 비반응군은 보다 많은 산소 공급을 요구하였으며 폐동맥 고혈압이 동반되는 경우가 많았다. 반응군은 입원 기간의 단축과 사망률의 감소 소견을 보였다. 고용량의 덱사메타손을 투여하는 것이 저용량에 비하여 보다 효과적으로 기계 환기에서 이탈을 유도한다는 근거는 도출되지 않았다. 패혈증은 덱사메타손 구제 치료 이후에 가장 빈번하게 발생하는 합병증이다. 결 론: 중증의 기관지폐 이형성증에서 폐동맥 고혈압이 발생하기 전에 덱사메타손 구제 치료를 시행하는 것이 치료 효과 측면에서 도움이 될 수 있다. 폐동맥 고혈압이 동반된 경우에는 합병증의 발생 가능성으로 인해 덱사메타손 구제 치료를 하지 않는 것이 바람직하다.

Purpose: The aim of this study is to investigate the current use of dexamethasone rescue therapy (DRT) for bronchopulmonary dysplasia (BPD). Methods: This is a retrospective study of 251 BPD patients managed in the neonatal intensive care units at Seoul National University Childrens Hospital and Seoul National University Bundang Hospital between March 2004 and August 2008. The demographic data and clinical characteristics of the mothers and infants were analyzed. The infants were compared based on DRT responsiveness. The DRT complications were investigated. Results: Ninety-three patients (37.1%) were classified with severe BPD, DRT was only given to patients with severe BPD. Dexamethasone was administered to 24 patients (9.6%) whose respiratory status had precluded extubation, which indicated that conventional BPD management had failed. Fourteen patients (58.3%) who received DRT were responsive. DRT non-responders required more oxygenation and more complicated with pulmonary arterial hypertension (PAH). Responder had shorter length's of hospitalization and lower mortality rates. High dose dexamethasone was no more effective in weaning neonates from the ventilatior than low dose dexamethasone. Sepsis was the most common complication of DRT. Conclusion: DRT is a valuable treatment for severe BPD ahead of PAH development. DRT should not be performed in BPD patients with PAH due to the possibility of complications.

키워드

참고문헌

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