Yapicioğlu Hacer, Yildizdaş Dinçer, Bayram Ibrahim, Sertdemir Yaşar, Yilmaz H Levent
Department of Paediatrics, Division of Neonatology, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey.
Pulm Pharmacol Ther. 2003;16(6):327-33. doi: 10.1016/S1094-5539(03)00088-9.
The aim of this prospectively designed study was to investigate the efficacy of surfactant (S) for acute respiratory distress syndrome (ARDS) in children.
Children with ARDS were included in this study. Surfactant (Survanta, Abbott, USA) was given intratracheally at a dose of 150 mg/kg every 12 h for a total of two doses. During the study period none of the patients received permissive hypercapnia, high frequency ventilation, nitric oxide or ECMO. Peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP), ventilation rate, mean airway pressure, tidal volume (TV), Murray index, PaO2/FiO2, ventilation index (VI), oxygen index (OI) and arterial oxygen tension difference (A-aDO2) were measured before and 48 h after surfactant treatment. Duration of mechanical ventilation therapy, duration in paediatric intensive care unit (PICU) and mortality rate were recorded.
Among the 36 children who met the inclusion criteria, 12 were treated with surfactant. The mean age was 72.5+/-56.2 months; 47% of children were male. Infants were ventilated by pressure-controlled ventilators whereas for older children volume-controlled ventilators were used. Sepsis (42%) was the main predisposing factor followed by pneumonia (25%) and malignancy (17%). The baseline characteristics including age, predisposing factors, gender, PIP, PEEP, A-aDO2, PaO2/FiO2, OI, TV, VI and Murray index were similar in the surfactant and non-surfactant (NS) group (p>0.05). There were significant improvements in PIP, PEEP, A-aDO2, PaO2/FiO2, OI, TV, VI and Murray index in the surfactant group after surfactant treatment compared with NS group (p<0.05). Duration of PICU stay and ventilator treatment was longer in NS group (14+/-3.7, 1.8+/-3.2 days vs. 9.2+/-3.1, 8.6+/-1.9 days), (p<0.05). Mortality rate was 42% in surfactant compared with 63% in the NS group, (p>0.05). Children in the surfactant group lived significantly longer (p<0.05).
Modified natural surfactant is an effective treatment option in children with ARDS for improving gas exchange, decreasing the use of ventilatory support and increasing survival time.
本前瞻性设计研究的目的是调查表面活性剂（S）对儿童急性呼吸窘迫综合征（ARDS）的疗效。
本研究纳入了患有ARDS的儿童。表面活性剂（Survanta，美国雅培公司）通过气管内给药，剂量为150mg/kg，每12小时一次，共给药两次。在研究期间，没有患者接受允许性高碳酸血症、高频通气、一氧化氮或体外膜肺氧合（ECMO）治疗。在表面活性剂治疗前和治疗后48小时测量吸气峰压（PIP）、呼气末正压（PEEP）、通气频率、平均气道压、潮气量（TV）、默里指数、动脉血氧分压/吸入氧分数值（PaO2/FiO2）、通气指数（VI）、氧合指数（OI）和动脉血氧分压差（A-aDO2）。记录机械通气治疗时间、儿科重症监护病房（PICU）住院时间和死亡率。
在符合纳入标准的36名儿童中，12名接受了表面活性剂治疗。平均年龄为72.5±56.2个月；47%的儿童为男性。婴儿使用压力控制通气机通气，而年龄较大的儿童使用容量控制通气机。脓毒症（42%）是主要的诱发因素，其次是肺炎（25%）和恶性肿瘤（17%）。表面活性剂组和非表面活性剂（NS）组的基线特征，包括年龄、诱发因素、性别、PIP、PEEP、A-aDO2、PaO2/FiO2、OI、TV、VI和默里指数相似（p>0.05）。与NS组相比，表面活性剂组在表面活性剂治疗后，PIP、PEEP、A-aDO2、PaO2/FiO2、OI、TV、VI和默里指数有显著改善（p<0.05）。NS组的PICU住院时间和通气治疗时间更长（分别为14±3.7天、1.8±3.2天，对比9.2±3.1天、8.6±1.9天），（p<0.05）。表面活性剂组的死亡率为42%，而NS组为63%，（p>0.05）。表面活性剂组的儿童存活时间明显更长（p<0.05）。
改良天然表面活性剂是治疗儿童ARDS的一种有效选择，可改善气体交换、减少通气支持的使用并延长生存时间。
