Armsby D H, Bellon G, Carlisle K, Rector D, Baldwin R, Long W, Stevenson D K, Ariagno R L
Department of Pediatrics, Stanford University School of Medicine, California 94305-5119.
Pediatr Pulmonol. 1992 Dec;14(4):206-13. doi: 10.1002/ppul.1950140403.
Recent research has demonstrated that Exosurf (EXSF), a newly synthesized artificial surfactant, increases survival when administered endotracheally to premature infants with RDS. This study examines the effects of EXSF on static respiratory system compliance (Crs). Thirty-four patients received two doses of EXSF in this rescue protocol. Crs (mL/cmH2O/kg) did not significantly change within the first 4 hours after either dose. However, Crs values did increase significantly (paired Student's t-test, P = 0.005) when data collected after the second dose (0.36 +/- 0.13 mL/cmH2O/kg) were compared to first week follow-up data (0.51 +/- 0.21 mL/cmH2O/kg). Crs data collected between 2 and 4 weeks after treatments were again not significantly different from non-concurrent control data collected at 3-4 weeks of life. The measurement of Crs in infants receiving EXSF may have been affected by an increase in lung inflation, which could mask an increase in Crs. We speculate that improved lung inflation may occur with less barotrauma in the first week of life due to surfactant replacement treatment and may in part explain the improved Crs seen at 1 week of age. Many investigators using different surfactants, dosing schedules, and pulmonary function methodologies to evaluate lung mechanics have reported that the improvement in compliance after surfactant treatment usually follows the clinical improvement in gas exchange. Additional studies are needed to explain the mechanism of early improvement following surfactant replacement in infants with RDS.
近期研究表明，新合成的人工表面活性剂Exosurf（EXSF）经气管内给药用于患有呼吸窘迫综合征（RDS）的早产儿可提高存活率。本研究考察了EXSF对静态呼吸系统顺应性（Crs）的影响。在该抢救方案中，34例患者接受了两剂EXSF。两剂给药后最初4小时内，Crs（mL/cmH₂O/kg）均无显著变化。然而，将第二剂给药后收集的数据（0.36±0.13 mL/cmH₂O/kg）与第一周随访数据（0.51±0.21 mL/cmH₂O/kg）相比较时，Crs值显著升高（配对t检验，P = 0.005）。治疗后2至4周收集的Crs数据与出生3至4周时收集的非同期对照数据再次无显著差异。接受EXSF治疗的婴儿Crs测量值可能受到肺膨胀增加的影响，这可能掩盖了Crs的升高。我们推测，由于表面活性剂替代治疗，出生后第一周肺膨胀改善可能伴发较小的气压伤，这可能部分解释了1周龄时Crs的改善。许多研究人员使用不同的表面活性剂、给药方案和肺功能评估方法来评估肺力学，他们报告称，表面活性剂治疗后顺应性的改善通常伴随着气体交换的临床改善。需要进一步研究来解释RDS婴儿表面活性剂替代治疗后早期改善的机制。
