Chang Hung-Yang, Hsu Chyong-Hsin, Kao Hsin-An, Hung Han-Yang, Chang Jui-Hsing, Peng Chun-Chih, Jim Wai-Tim
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2003 May;102(5):326-30.
Despite the development of new adjuvant therapies, meconium aspiration syndrome (MAS) remains a serious respiratory disorder in neonates. Surfactant inactivation by meconium can be overcome by use of exogenous surfactant. This study sought to assess the efficacy and safety of dilute surfactant lavage at 2 different concentrations to treat severe MAS.
We retrospectively reviewed the charts of all term infants with a diagnosis of MAS who had an oxygenation index (OI) > 20 during a 2-year period. Tracheobronchial lavage was performed with a dilute surfactant suspension (5 mg/mL or 10 mg/mL) to reach a total dose of 60 to 70 mg/kg of phospholipid, administered in aliquots of 2 mL.
The records of 22 patients were reviewed, of whom 12 had undergone lavage. These patients were subdivided into low-concentration (surfactant concentration, 5 mg/mL; n = 6) and high-concentration (surfactant concentration, 10 mg/mL; n = 6) subgroups. There were no significant differences in demographic characteristics between these 2 subgroups. The lavaged infants had a significantly higher arterial partial pressure of oxygen (PaO(2)) 24 hours after lavage than the infants without lavage (178.3 mm Hg vs 80.6 mm Hg, p < 0.05). The incidence of pneumothorax (1/12 vs 7/10, p < 0.05) and requirement for inhaled nitric oxide (5/12 vs 9/10, p < 0.05) were significantly lower in the lavaged group. All infants tolerated the procedure well except for 2 with transient complications. There were no significant differences in duration of lavage, response and complications between subgroups lavaged at low and high surfactant concentration.
Early lavage with dilute surfactant solution at a phospholipid concentration of either 5 mg/mL or 10 mg/mL is effective for the treatment of severe MAS. Further large-scale, prospective, randomized, controlled trials are necessary to establish the optimal dose, concentration, surfactant product, and instillation method of this treatment before it can be recommended for routine use.
尽管新型辅助治疗方法不断发展，但胎粪吸入综合征（MAS）仍是新生儿严重的呼吸系统疾病。胎粪导致的表面活性剂失活可通过使用外源性表面活性剂来克服。本研究旨在评估两种不同浓度的稀释表面活性剂灌洗治疗重度MAS的疗效和安全性。
我们回顾性分析了在两年期间内所有诊断为MAS且氧合指数（OI）>20的足月儿的病历。采用稀释表面活性剂混悬液（5mg/mL或10mg/mL）进行气管支气管灌洗，使磷脂总量达到60至70mg/kg，分2mL aliquots给药。
回顾了22例患者的记录，其中12例接受了灌洗。这些患者被分为低浓度（表面活性剂浓度5mg/mL；n = 6）和高浓度（表面活性剂浓度10mg/mL；n = 6）亚组。这两个亚组的人口统计学特征无显著差异。灌洗婴儿在灌洗后24小时的动脉血氧分压（PaO₂）显著高于未灌洗婴儿（178.3mmHg对80.6mmHg，p < 0.05）。灌洗组气胸发生率（1/12对7/10，p < 0.05）和吸入一氧化氮需求率（5/12对9/10，p < 0.05）显著更低。除2例有短暂并发症外，所有婴儿对该操作耐受性良好。低表面活性剂浓度和高表面活性剂浓度灌洗的亚组在灌洗持续时间、反应和并发症方面无显著差异。
早期使用磷脂浓度为5mg/mL或10mg/mL的稀释表面活性剂溶液灌洗对治疗重度MAS有效。在推荐该治疗方法用于常规治疗之前，有必要进行进一步的大规模、前瞻性、随机对照试验，以确定其最佳剂量、浓度、表面活性剂产品和滴注方法。
