Lisawa Jacek, Pietrasik Dariusz, Zwoliński Jerzy, Gierowska-Bogusz Barbara, Lewandowski Leszek, Chazan Bogdan
Klinika Połoznictwa i Ginekologii IMD, Instytut Matki i Dziecka w Warszawie.
Med Wieku Rozwoj. 2003 Jul-Sep;7(3 Suppl 1):255-60.
The importance of steroids given antenatally to the mothers in prevention of the respiratory distress syndrome (RDS) is unquestionable. Also intra tracheal surfactant application in newborn is proven method of prevention and treatment of RDS. However both options have some limitations and new methods useful in prevention of RDS are still needed. The aim of the study was to evaluate the efficiency and safety of the procedure of the intraamniotic surfactant supply as RDS prevention. Natural surfactant (Alveofact - Boehringer Ingelheim) has been given to 15 women at 24-32 weeks of pregnancy, two hours before expected childbirth (mainly cesarean section). To 8 of these women corticosteroids have been earlier administered. Just before surfactant injection amniotic liquid samples were taken to confirm lung immaturity and the patients were administered Aminophilline intravenously to provoke fetal breathing movements. Surfactant has been administered through the needle under direct ultrasound guidance into the amniotic cavity as close as possible to the fetal mouth and nose. Patients with the evidence of chorionamnionitis and fetal malformations were excluded from the study. No complications were observed during and after the procedure. None of the newborns had symptoms of severe asphyxia, the birth weight comprised between 670-1650 g (mean 1207). There was radiological evidence of RDS in two newborns and in 7 mechanical ventilation was needed. Of 15 newborns 13 survived (86.6%). There was no need for postpartum surfactant therapy in any case. Some authors expressed their view that this method is promising and further studies are desirable. In our study surfactant has been injected into the amniotic cavity shortly before childbirth, and Aminophilline has been administered intravenously in order to provoke fetal breathing movements before surfactant injection. The safety of the procedure was confirmed and the results of intraamniotic surfactant supply seems to be favourable to newborns. Small number of cases does not allow to draw any far-reaching conclusions. Still our preliminary results are encouraging and the study should be continued.
产前给予母亲类固醇激素对预防呼吸窘迫综合征（RDS）的重要性是毋庸置疑的。在新生儿中应用气管内表面活性剂也是预防和治疗RDS的已证实方法。然而，这两种方法都有一些局限性，仍然需要预防RDS的新方法。本研究的目的是评估羊膜腔内注入表面活性剂预防RDS的有效性和安全性。在妊娠24 - 32周时，于预期分娩前两小时（主要是剖宫产）给15名妇女使用天然表面活性剂（肺泡表面活性物质 - 勃林格殷格翰公司生产）。其中8名妇女此前已使用过皮质类固醇。在注入表面活性剂之前，采集羊水样本以确认肺不成熟，并给患者静脉注射氨茶碱以诱发胎儿呼吸运动。在直接超声引导下，通过针头将表面活性剂尽可能靠近胎儿口鼻注入羊膜腔。有绒毛膜羊膜炎和胎儿畸形证据的患者被排除在研究之外。在操作过程中和操作后均未观察到并发症。没有新生儿出现严重窒息症状，出生体重在670 - 1650克之间（平均1207克）。两名新生儿有RDS的影像学证据，7名新生儿需要机械通气。15名新生儿中有13名存活（86.6%）。在任何情况下都不需要产后表面活性剂治疗。一些作者认为这种方法很有前景，需要进一步研究。在我们的研究中，在分娩前不久将表面活性剂注入羊膜腔，并在注入表面活性剂之前静脉注射氨茶碱以诱发胎儿呼吸运动。该操作的安全性得到了证实，羊膜腔内注入表面活性剂的结果似乎对新生儿有利。病例数较少，无法得出任何深远结论。尽管如此，我们的初步结果令人鼓舞，该研究应继续进行。
