Fujii Alan M, Carillo Marie
Department of Pediatrics, Boston Medical Center, Boston, Massachusetts 02118, USA.
Drugs Today (Barc). 2009 Sep;45(9):697-709.
Exogenous surfactant treatment of premature infants with respiratory distress syndrome (RDS) has been the standard of care for the past two decades. There are many studies comparing various surfactant preparations. Data are clear that the synthetic surfactants without surfactant proteins are inferior to animal-derived surfactant preparations. Less compelling are the data regarding the relative efficacy of the various animal-derived surfactants available, but a pattern has evolved favoring surfactant preparations with higher concentrations of phospholipids and surfactant proteins. A higher initial dose of phospholipids may also be important, especially for preterm infants less than 32 weeks of gestation. Development has begun of new synthetic surfactants with surfactant protein analogs or recombinant surfactant proteins, which are not yet available in the United States. Synthetic surfactants hold the possibility of surfactant treatments without potential animal-born infectious agents or animal proteins that could induce an immune response in fragile premature infants with multiple medical problems. The goal of this review is to assess the comparison of available animal-derived surfactants and what is known of their comparison. with the newer synthetic surfactants. In addition, the possible direct and indirect effects of surfactant administration on regional blood flow are discussed, with their potential relationship to the volume of surfactant administered.
在过去二十年中，外源性表面活性剂治疗早产新生儿呼吸窘迫综合征（RDS）一直是标准治疗方法。有许多研究比较了各种表面活性剂制剂。数据表明，不含表面活性蛋白的合成表面活性剂不如动物源性表面活性剂制剂。关于现有各种动物源性表面活性剂的相对疗效的数据说服力较弱，但已形成一种趋势，即倾向于使用磷脂和表面活性蛋白浓度较高的表面活性剂制剂。较高的初始磷脂剂量可能也很重要，特别是对于孕周小于32周的早产儿。含有表面活性蛋白类似物或重组表面活性蛋白的新型合成表面活性剂已开始研发，但在美国尚未上市。合成表面活性剂有可能用于表面活性剂治疗，而不存在潜在的动物源性传染因子或可能在患有多种疾病的脆弱早产儿中引发免疫反应的动物蛋白。本综述的目的是评估现有动物源性表面活性剂的比较情况以及它们与新型合成表面活性剂的比较情况。此外，还讨论了表面活性剂给药对局部血流可能产生的直接和间接影响，以及它们与表面活性剂给药量的潜在关系。
