Hung Han-Yang, Jim Wai-Tim, Hsu Chyong-Hsin, Chang Jui-Hsing, Peng Chun-Chi, Shih Shin-Lin, Chang Hung-Yang, Kao Hsin-An
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Acta Paediatr Taiwan. 2006 Jul-Aug;47(4):181-6.
Surfactant lavage has been used to treat neonatal meconium aspiration syndrome (MAS).
To assess the effects of lavage with a small volume of dilute surfactant in neonates with MAS, and compare the results with those of historical controls treated with larger volumes.
From August 2002 to June 2005, we treated 11 newborns with MAS using 20 ml of dilute surfactant at a phospholipid concentration of 10 mg/ml (SVL group). We compared the results with those of 9 infants previously treated with large-volume lavage (LVL group), using 40 ml of dilute surfactant, 5 mg/ml.
Both groups were similar at baseline except for a higher mean birth weight in the LVL group (3.29+/-0.36 vs 2.92+/-0.4 kg, P = 0.04). The lavage procedure was longer in the LVL than the SVL group (48.89 +/-7.41 vs. 30.91+/-5.83 mins, P <0.001). Measures of oxygenation, including mean PaO2, oxygenation index, and arterial/alveolar 02 ratio, showed no significant difference between the two groups. Adverse events in the LVL group included transient hypoxemia in 3 infants and white- out on chest x-ray in 5 cases. None of the patients in the SVL group had these findings. The peak mean airway pressure in.the LVL group was higher than that in the SVL group (16.0+/-2. 65 vs 13.3+/-3.01 cmH2O, P = 0.046).
SVL has the same benefits in neonatal MAS as LVL. However, SVL appears to be associated with fewer adverse events.
表面活性剂灌洗已用于治疗新生儿胎粪吸入综合征（MAS）。
评估小剂量稀释表面活性剂灌洗对患有MAS的新生儿的效果，并将结果与接受大剂量灌洗的历史对照进行比较。
2002年8月至2005年6月，我们使用20 ml磷脂浓度为10 mg/ml的稀释表面活性剂治疗了11例患有MAS的新生儿（小剂量表面活性剂灌洗组）。我们将结果与9例先前接受大剂量灌洗（大剂量灌洗组）的婴儿进行比较，大剂量灌洗组使用40 ml浓度为5 mg/ml的稀释表面活性剂。
除大剂量灌洗组平均出生体重较高外（3.29±0.36 vs 2.92±0.4 kg，P = 0.04），两组在基线时相似。大剂量灌洗组的灌洗过程比小剂量表面活性剂灌洗组长（48.89±7.41 vs. 30.91±5.83分钟，P <0.001）。包括平均动脉血氧分压、氧合指数和动脉/肺泡氧比值在内的氧合指标在两组之间无显著差异。大剂量灌洗组的不良事件包括3例婴儿出现短暂性低氧血症，5例胸部X线出现白肺。小剂量表面活性剂灌洗组的患者均无这些表现。大剂量灌洗组的平均气道压峰值高于小剂量表面活性剂灌洗组（16.0±2.65 vs 13.3±3.01 cmH2O，P = 0.046）。
小剂量表面活性剂灌洗在新生儿MAS中的益处与大剂量灌洗相同。然而，小剂量表面活性剂灌洗似乎与较少的不良事件相关。
