Tibby S M, Hatherill M, Wright S M, Wilson P, Postle A D, Murdoch I A
Department of Pediatric Intensive Care, Guy's Hospital, London, United Kingdom.
Am J Respir Crit Care Med. 2000 Oct;162(4 Pt 1):1251-6. doi: 10.1164/ajrccm.162.4.9909004.
Infants with respiratory syncytial virus (RSV) bronchiolitis are deficient in surfactant, both in quantity and ability to reduce surface tension. New evidence suggests surfactant has a role in maintaining the patency of conducting airways, which has implications for RSV bronchiolitis. A randomized, controlled pilot study was undertaken to assess the effects of exogenous surfactant supplementation to RSV-positive infants on pulmonary mechanics, indices of gas exchange, and the phospholipid composition of bronchoalveolar lavage fluid (BALF). Nineteen ventilated infants (median corrected age 4 wk) received either two doses of surfactant (Survanta, 100 mg/kg) within 24 and 48 h of mechanical ventilation (n = 9), or air placebo (n = 10). Static lung compliance and resistance of infants in the placebo but not in the surfactant-treated group became progressively worse over the first 30 h following enrollment. Although no significant acute changes in gas exchange parameters were seen following surfactant, infants in the surfactant group showed a more rapid improvement in oxygenation and ventilation indices over the first 60 h of ventilation. Surfactant status was assessed from the concentration ratio in BALF of the disaturated phospholipid species dipalmitoylphosphatidylcholine to that of the monounsaturated species palmitoyloleoylphosphatidylcholine. This ratio correlated with both lung compliance (positively) and resistance (negatively), and over time increased in the treated group and declined in placebo infants. The data from this pilot study suggest that functional surfactant has a role in maintaining small airway patency as well as lung compliance in infants infected with RSV and an outcome study is now warranted.
患有呼吸道合胞病毒（RSV）细支气管炎的婴儿在表面活性物质方面存在不足，无论是数量还是降低表面张力的能力。新证据表明，表面活性物质在维持传导气道通畅方面发挥作用，这对RSV细支气管炎具有重要意义。一项随机对照试验性研究旨在评估对RSV阳性婴儿补充外源性表面活性物质对肺力学、气体交换指标以及支气管肺泡灌洗液（BALF）磷脂组成的影响。19名接受机械通气的婴儿（中位矫正年龄4周）在机械通气24小时和48小时内分别接受两剂表面活性物质（固尔苏，100mg/kg）（n = 9）或空气安慰剂（n = 10）。在入组后的前30小时内，安慰剂组婴儿的静态肺顺应性和阻力逐渐变差，而表面活性物质治疗组则不然。尽管表面活性物质治疗后气体交换参数未见明显急性变化，但表面活性物质组婴儿在通气的前60小时内氧合和通气指标改善更快。通过BALF中饱和磷脂二棕榈酰磷脂酰胆碱与单不饱和磷脂棕榈酰油酰磷脂酰胆碱的浓度比来评估表面活性物质状态。该比值与肺顺应性呈正相关，与阻力呈负相关，且随着时间推移，治疗组该比值升高，安慰剂组婴儿该比值下降。这项试验性研究的数据表明，功能性表面活性物质在维持感染RSV婴儿的小气道通畅以及肺顺应性方面发挥作用，现在有必要进行一项结局研究。
