Ogawa Y, Shimizu H
Department of Pediatrics, Saitams Medical Center, Saitama Medical School, Japan.
Acta Paediatr Taiwan. 2000 Sep-Oct;41(5):241-5.
Meconium aspiration syndrome (MAS) is characterized by the atelectasis due to the complete airway obstruction, emphysema and air leak syndrome resulted from the partial obstruction of airway, chemical pneumonitis, and surfactant dysfunction. As far as meconium is present in the airway, exogenous surfactant will be inactivated rather quickly even given as multiple doses. MAS can easily develop persistent pulmonary hypertension of the newborn. Therefore, the removal of meconium from the airway rather than the surfactant replacement therapy should be the cardinal step for the treatment of MAS. Our previous studies revealed that the removal of meconium from airway by the tracheobronchial lavage with diluted surfactant solution, 100 mg/10 mL/Kg of Surfactant-TA, resulted in the recovery of both blood gas values and lung compliance to the normal range. Thus, the current strategies of management of MAS are the selective intubation with toileting only on infants with severe distress at birth, and the early airway lavage with diluted surfactant solution, followed by high frequency oscillatory ventilation, which may prevent the further injuries in the fragile neonatal lung.
胎粪吸入综合征（MAS）的特征包括：因气道完全阻塞导致肺不张、气道部分阻塞引起的肺气肿和气漏综合征、化学性肺炎以及表面活性物质功能障碍。只要气道中有胎粪存在，即使多次给予外源性表面活性物质，它也会很快失活。MAS很容易发展为新生儿持续性肺动脉高压。因此，从气道清除胎粪而非表面活性物质替代疗法应是治疗MAS的关键步骤。我们之前的研究表明，用稀释的表面活性物质溶液（100mg/10mL/Kg的Surfactant-TA）进行气管支气管灌洗以清除气道中的胎粪，可使血气值和肺顺应性恢复到正常范围。因此，目前MAS的治疗策略是仅对出生时严重窘迫的婴儿进行选择性插管并清理气道，以及早期用稀释的表面活性物质溶液进行气道灌洗，随后进行高频振荡通气，这可能会防止脆弱的新生儿肺受到进一步损伤。
