Kribs Angela, Härtel C, Kattner E, Vochem M, Küster H, Möller J, Müller D, Segerer H, Wieg C, Gebauer C, Nikischin W, Wense A v d, Herting E, Roth B, Göpel W
Neonatologie, Universitätskinderklinik Köln, Köln, Germany.
Klin Padiatr. 2010 Jan-Feb;222(1):13-7. doi: 10.1055/s-0029-1241867. Epub 2010 Jan 18.
Recently in a report of a single center a method has been described to apply surfactant via a thin endotracheal catheter to very low birth weight infants spontaneously breathing with nasal continuous positive airway pressure. We now analyzed available multicenter data.
In a multicenter study investigating genetic risk factors, clinical and outcome data and data of antenatal and postnatal treatment of infants with a birth weight below 1,500 g were prospectively recorded. The measures of infants treated with the new method of surfactant application were compared to those of infants who received standard care. The analysis was restricted to infants with a gestational age below 31 weeks (n=1,541).
319 infants were treated with the new method and 1,222 with standard care. The need for mechanical ventilation during the first 72 h (29% vs. 53%, p<0.001), the rate of bronchopulmonary dysplasia defined as oxygen at 36 weeks of postmenstrual age (10.9 % vs. 17.5%, p=0.004) and the rate of death or bronchopulmonary dysplasia were significantly lower in the treatment group than in the standard care group. Surfactant, theophyllin, caffeine and doxapram were significantly more often and analgetics, catecholamines and dexamethasone were significantly less frequently used in the treatment group.
A new method of surfactant application was associated with a lower prevalence of mechanical ventilation and better pulmonary outcome. A prospective controlled trial is required to determine whether this approach is superior to standard care.
最近在一份单中心报告中描述了一种通过细气管内导管向经鼻持续气道正压自主呼吸的极低出生体重儿应用表面活性剂的方法。我们现在分析了现有的多中心数据。
在一项调查遗传危险因素的多中心研究中，前瞻性记录了出生体重低于1500g婴儿的临床和结局数据以及产前和产后治疗数据。将采用新表面活性剂应用方法治疗的婴儿的各项指标与接受标准治疗的婴儿进行比较。分析仅限于孕周小于31周的婴儿（n = 1541）。
319名婴儿采用新方法治疗，1222名婴儿接受标准治疗。治疗组在出生后72小时内需要机械通气的比例（29%对53%，p<0.001）、以孕龄36周时需吸氧定义的支气管肺发育不良发生率（10.9%对17.5%，p = 0.004）以及死亡或支气管肺发育不良的发生率均显著低于标准治疗组。治疗组使用表面活性剂、茶碱、咖啡因和多沙普仑的频率显著更高，而使用镇痛药、儿茶酚胺和地塞米松的频率显著更低。
一种新的表面活性剂应用方法与机械通气发生率较低和更好的肺部结局相关。需要进行一项前瞻性对照试验来确定这种方法是否优于标准治疗。
