Nuntnarumit P, Bada H S, Yang W, Korones S B
Division of Neonatal-Perinatal Medicine, University of Tennessee, Memphis, USA.
J Perinatol. 2000 Jun;20(4):240-3. doi: 10.1038/sj.jp.7200358.
To determine the effects of bovine natural surfactant (beractant) instillation on cerebral hemodynamics in preterm infants with respiratory distress syndrome (RDS).
Preterm infants who required surfactant for RDS were enrolled. Cerebral blood flow velocity (CBFV) waveforms from the pericallosal artery were analyzed by pulsed Doppler ultrasonography with the anterior fontanel serving as an acoustic window. CBFV was measured before and at 5, 10, 20, and 30 minutes after the first dose of a bolus instillation of surfactant in four aliquots. Simultaneously with CBFV measurements, mean blood pressure (MBP), heart rate, and ventilator settings were recorded. pH, PACO2, and PAO2 before and at 30 minutes after surfactant administration were also determined.
The 30 enrolled preterm infants had a mean birth weight of 973 gm (513 to 1996 gm) and a mean gestational age of 27 weeks (23 to 33 weeks). Mean postnatal age at surfactant administration was 4.7 +/- 2.7 hours. There were no significant changes in pH and PACO2 before and at 30 minutes after surfactant (before surfactant: mean pH of 7.29 +/- 0.07 and mean PACO2 of 44.4 +/- 7.1 torr; after surfactant: mean pH of 7.31 +/- 0.07 and mean PACO2 of 42.7 +/- 8.3 torr). PAO2 increased significantly from a pre-surfactant mean of 83 torr to 130 torr at 30 minutes after surfactant (p < 0.05), with no significant changes in mean airway pressure. There were no significant changes in MBP, heart rate, mean CBFV, peak systolic flow velocity, and diastolic flow velocity before and after surfactant instillation regardless of gestational age. Individual changes in mean CBFV were related to MBP changes (p < 0.001, linear mixed models with random effects).
In low birth weight infants with RDS, bovine surfactant instillation is not associated with a significant alteration in cerebral hemodynamics. However, the direct relationship between CBFV and MBP is consistent with the reported pressure-passive cerebral circulation in sick preterm infants.
确定牛肺表面活性物质（固尔苏）滴注对呼吸窘迫综合征（RDS）早产儿脑血流动力学的影响。
纳入因RDS需要使用肺表面活性物质的早产儿。以囟门作为声窗，通过脉冲多普勒超声分析胼周动脉的脑血流速度（CBFV）波形。在首次分四等份大剂量滴注肺表面活性物质之前以及之后5、10、20和30分钟测量CBFV。在测量CBFV的同时，记录平均血压（MBP）、心率和呼吸机设置。还测定了肺表面活性物质给药前及给药后30分钟时的pH值、动脉血二氧化碳分压（PACO2）和动脉血氧分压（PAO2）。
纳入的30例早产儿平均出生体重为973克（513至1996克），平均胎龄为27周（23至33周）。肺表面活性物质给药时的平均出生后年龄为4.7±2.7小时。肺表面活性物质给药前及给药后30分钟时，pH值和PACO2无显著变化（肺表面活性物质给药前：平均pH值为7.29±0.07，平均PACO2为44.
