Department of Paediatrics, Royal Hobart Hospital and University of Tasmania, Hobart, Australia.
J Pediatr. 2011 Mar;158(3):383-389.e2. doi: 10.1016/j.jpeds.2010.08.044. Epub 2010 Oct 13.
To evaluate whether lung lavage with surfactant changes the duration of mechanical respiratory support or other outcomes in meconium aspiration syndrome (MAS).
We conducted a randomized controlled trial that enrolled ventilated infants with MAS. Infants randomized to lavage received two 15-mL/kg aliquots of dilute bovine surfactant instilled into, and recovered from, the lung. Control subjects received standard care, which in both groups included high frequency ventilation, nitric oxide, and, where available, extracorporeal membrane oxygenation (ECMO).
Sixty-six infants were randomized, with one ineligible infant excluded from analysis. Median duration of respiratory support was similar in infants who underwent lavage and control subjects (5.5 versus 6.0 days, P = .77). Requirement for high frequency ventilation and nitric oxide did not differ between the groups. Fewer infants who underwent lavage died or required ECMO: 10% (3/30) compared with 31% (11/35) in the control group (odds ratio, 0.24; 95% confidence interval, 0.060-0.97). Lavage transiently reduced oxygen saturation without substantial heart rate or blood pressure alterations. Mean airway pressure was more rapidly weaned in the lavage group after randomization.
Lung lavage with dilute surfactant does not alter duration of respiratory support, but may reduce mortality, especially in units not offering ECMO.
评估肺灌洗加用表面活性物质是否会改变胎粪吸入综合征（MAS）患儿机械通气支持的时间或其他结局。
我们开展了一项随机对照试验，纳入了需要通气的 MAS 患儿。随机分至灌洗组的患儿接受了两次 15ml/kg 的稀释牛肺表面活性物质灌洗，每次灌洗后回收 15ml/kg。对照组患儿接受标准治疗，两组均接受高频通气、一氧化氮吸入治疗，有条件时给予体外膜肺氧合（ECMO）治疗。
共有 66 例患儿随机分组，1 例因不满足纳入标准而被排除分析。灌洗组与对照组患儿的机械通气支持时间中位数相近（5.5 天 vs. 6.0 天，P =.77）。高频通气和一氧化氮的使用需求在两组间无差异。灌洗组死亡或需要 ECMO 的患儿较少：10%（3/30）与对照组的 31%（11/35）（比值比，0.24；95%置信区间，0.060-0.97）。灌洗会短暂降低氧饱和度，但不会显著改变心率或血压。随机分组后，灌洗组的平均气道压更快降低。
肺灌洗加用稀释表面活性物质不会改变呼吸支持时间，但可能降低死亡率，特别是在未开展 ECMO 的单位。
