Janssen Daphne J M T, Tibboel Dick, Carnielli Virgilio P, van Emmen Esther, Luijendijk Ingrid H T, Darcos Wattimena J L, Zimmermann Luc J I
Department of Pediatrics/Neonatology, Sophia Children's Hospital/Erasmus University Rotterdam, The Netherlands.
J Pediatr. 2003 Mar;142(3):247-52. doi: 10.1067/mpd.2003.94.
We measured surfactant phosphatidylcholine (PC) pool size and half-life in human congenital diaphragmatic hernia (CDH) patients who required extracorporeal membrane oxygenation (ECMO). Study design Surfactant PC pool size and half-life were measured by endotracheal administration of deuterium-labeled dipalmitoylphosphatidylcholine in 8 neonates with CDH on ECMO (CDH-ECMO), in 7 neonates with meconium aspiration syndrome on ECMO (MAS-ECMO), and in 6 ventilated infants (NON-ECMO).
Lung PC pool size in the CDH-ECMO group was 73 +/- 17 mg/kg (mean +/- SEM), which was not significantly different from the MAS-ECMO (50 +/- 18 mg/kg) and the NON-ECMO group (69 +/- 38 mg/kg). Surfactant PC concentration in tracheal aspirates was not different between groups (6 mg/mL). However, the percentage of palmitic acid in surfactant PC was significantly lower in the MAS-ECMO (56.3%) and the NON-ECMO (55.8%) group compared with the CDH-ECMO (67.6%) group. Surfactant PC half-life (24 hours) was not different between the groups. A correlation was found between the surfactant PC half-life and the duration of ECMO.
These data show no decreased surfactant PC pool size in high risk CDH patients who require ECMO. A shorter half-life of surfactant PC, indicating a faster turnover, may result in a faster improvement of the pulmonary condition during ECMO.
我们测量了需要体外膜肺氧合（ECMO）的先天性膈疝（CDH）患儿的表面活性物质磷脂酰胆碱（PC）储备量和半衰期。研究设计 通过气管内给予氘标记的二棕榈酰磷脂酰胆碱，测量了8例接受ECMO的CDH新生儿（CDH-ECMO组）、7例接受ECMO的胎粪吸入综合征新生儿（MAS-ECMO组）和6例机械通气婴儿（非ECMO组）的表面活性物质PC储备量和半衰期。
CDH-ECMO组的肺PC储备量为73±17mg/kg（均值±标准误），与MAS-ECMO组（50±18mg/kg）和非ECMO组（69±38mg/kg）相比，差异无统计学意义。各小组气管吸出物中的表面活性物质PC浓度无差异（约6mg/mL）。然而，与CDH-ECMO组（67.6%）相比，MAS-ECMO组（56.3%）和非ECMO组（55.8%）表面活性物质PC中棕榈酸的百分比显著降低。各小组间表面活性物质PC半衰期（约24小时）无差异。表面活性物质PC半衰期与ECMO持续时间之间存在相关性。
这些数据表明，需要ECMO的高危CDH患者的表面活性物质PC储备量没有减少。表面活性物质PC半衰期较短，表明周转较快，这可能导致ECMO期间肺部状况更快改善。
