表面活性剂给药会急性影响极低出生体重儿的脑和全身血流动力学以及气体交换。

Surfactant administration acutely affects cerebral and systemic hemodynamics and gas exchange in very-low-birth-weight infants.

作者信息

Kaiser Jeffrey R, Gauss C Heath, Williams D Keith

机构信息

Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

出版信息

J Pediatr. 2004 Jun;144(6):809-14. doi: 10.1016/j.jpeds.2004.03.022.

DOI:10.1016/j.jpeds.2004.03.022

PMID:15192631

Abstract

OBJECTIVES

To determine whether surfactant administration affects cerebral and systemic hemodynamics and gas exchange in very low birth weight infants and to determine the predominant factor influencing changes in mean cerebral blood flow velocity (mCBFv) after surfactant instillation.

STUDY DESIGN

Fourteen very low birth weight infants with respiratory distress syndrome had continuous monitoring of mCBFv, Paco(2), mean arterial blood pressure (MABP), and Pao(2) before, during, and after the second dose of surfactant. Peak values and relative changes of the 4 variables for 45 minutes after surfactant were calculated. Logistic regression was used to determine the predominant factor influencing changes in mCBFv after surfactant.

RESULTS

Birth weight was 832 +/- 162 grams and gestational age was 25.7 +/- 1.5 weeks. The time from birth to monitoring was 6.9 +/- 1.0 hours. Mean CBFv increased 75.7% +/- 51.6% after surfactant and peaked at 14.4 +/- 5.9 minutes. Paco(2) was highly associated (OR=107.3, P <.0001) with mCBFv; as Paco(2) increased, mCBFv increased. In contrast, MABP (OR=6.7, P=.047) had less impact on mCBFv. Pao(2) was not associated with mCBFv.

CONCLUSIONS

The increases in mCBFv after surfactant administration were predominantly due to increases in Paco(2) and not changes in MABP.

摘要

目的

确定表面活性剂给药是否会影响极低出生体重儿的脑和全身血流动力学及气体交换，并确定影响表面活性剂滴入后平均脑血流速度（mCBFv）变化的主要因素。

研究设计

14例患有呼吸窘迫综合征的极低出生体重儿在第二次给予表面活性剂之前、期间和之后，持续监测mCBFv、动脉血二氧化碳分压（Paco₂）、平均动脉血压（MABP）和动脉血氧分压（Pao₂）。计算表面活性剂给药后45分钟内这4个变量的峰值和相对变化。采用逻辑回归确定影响表面活性剂给药后mCBFv变化的主要因素。

结果

出生体重为832±162克，胎龄为25.7±1.5周。从出生到监测的时间为6.9±1.0小时。表面活性剂给药后平均CBFv增加75.7%±51.6%，并在14.4±5.9分钟达到峰值。Paco₂与mCBFv高度相关（OR=107.3，P<.0001）；随着Paco₂升高，mCBFv增加。相比之下，MABP（OR=6.7，P=.047）对mCBFv的影响较小。Pao₂与mCBFv无关。