Köksal Nilgün, Akpinar Reyhan, Cetinkaya Merih
Division of Neonatology, Uludağ University Faculty of Medicine, Bursa, Turkey.
Turk J Pediatr. 2009 Nov-Dec;51(6):556-64.
The aim of this study was to determine whether early administration (2 hours after the first surfactant dose) of the second surfactant dose would be superior to late surfactant treatment (6 hours after the first surfactant dose) in preterm infants with severe respiratory distress syndrome. Between June 2003 and March 2005, 40 newborns born with respiratory distress syndrome in Uludağ University Hospital were investigated in this prospective study. The inclusion criteria for the recruitment of the infants were: age < or = 2 hours, birth weight between 600-2500 g, gestational age between 24-36 weeks, X-ray consistent with respiratory distress syndrome, and need for mechanical ventilation with inspiratory oxygen fraction > or = 0.4 and mean airway pressure > or = 7 cm H2O to obtain arterial pressure of oxygen between 70-80 mmHg. Infants with lethal congenital anomalies or being treated with high-frequency oscillatory ventilation were excluded from the study. Birth weight, gestational age, gender, and Apgar scores were recorded and complications of the surfactant therapy were examined. Twenty boys and 20 girls were enrolled in the study. The first surfactant dose was administered in the first hour of life in all infants. The second surfactant dose was given 2 hours after the first dose in 20 of them and 6 hours after the first dose in the other 20. Infants in both groups (early versus late) were similar with respect to gestational age, birth weight, gender, and the rate of prenatal corticosteroids. There were also no significant differences between the two groups in terms of the response to surfactant therapy and complications. The results of this study show that administration of the second surfactant dose earlier is as effective as late administration, and it may be suggested that the second surfactant dose can be applied earlier in severe respiratory distress syndrome.
本研究的目的是确定在患有严重呼吸窘迫综合征的早产儿中，第二次表面活性剂剂量的早期给药（首次表面活性剂剂量后2小时）是否优于晚期表面活性剂治疗（首次表面活性剂剂量后6小时）。在2003年6月至2005年3月期间，在这项前瞻性研究中对乌鲁达格大学医院出生的40例患有呼吸窘迫综合征的新生儿进行了调查。纳入婴儿的标准为：年龄≤2小时，出生体重在600 - 2500克之间，胎龄在24 - 36周之间，X线与呼吸窘迫综合征相符，且需要机械通气，吸入氧分数≥0.4且平均气道压≥7厘米水柱以获得70 - 80毫米汞柱的动脉血氧分压。患有致命先天性异常或接受高频振荡通气治疗的婴儿被排除在研究之外。记录出生体重、胎龄、性别和阿氏评分，并检查表面活性剂治疗的并发症。20名男孩和20名女孩纳入了研究。所有婴儿在出生后第一小时内给予首次表面活性剂剂量。其中20例在首次剂量后2小时给予第二次表面活性剂剂量，另外20例在首次剂量后6小时给予。两组（早期与晚期）婴儿在胎龄、出生体重、性别和产前使用皮质类固醇的比例方面相似。两组在表面活性剂治疗反应和并发症方面也无显著差异。本研究结果表明，早期给予第二次表面活性剂剂量与晚期给药一样有效，并且可以建议在严重呼吸窘迫综合征中更早地应用第二次表面活性剂剂量。
