Speer C P, Harms K, Herting E, Neumann N, Curstedt T, Robertson B
Department of Pediatrics, University of Göttingen, Federal Republic of Germany.
Lung. 1990;168 Suppl:870-6. doi: 10.1007/BF02718222.
26 preterm infants with severe respiratory distress syndrome (RDS) have been treated at different ages with a single dose of natural porcine surfactant (Curosurf, 200 mg/kg). Criteria for treatment included clinical and radiological signs of severe RDS (grade III-IV), requirement of artificial ventilation and an FiO2 greater than or equal to 0.6. Nineteen neonates have been subjected to early treatment (2-15 h of age, mean birth weight SD: 1201 +/- 387 g) and 7 patients to late treatment (greater than 15 h to 48 h of age, birth weight SD 1624 +/- 649 g). Average FiO2 before treatment was 0.88 in early-treated patients and 0.8 in late-treated patients, age at treatment was 4.6 h and 36 h, respectively (median). Both early- and late-treated infants exhibited an improvement in oxygenation (more than twofold increase of the PaO2/FiO2 ratio) within 5 minutes after initiation of therapy. Average duration of intermittent pressure ventilation was 15 days in the early treatment group and 19 days in the late treatment group. Total exposition to greater than 21% oxygen was 21 days in early-treated and 48 days in late-treated infants. Pneumothorax occurred in none of the patients. All early treated infants survived without signs of severe bronchopulmonary dysplasia (BPD greater than 21% O2, greater than 90 days plus radiological changes). However, two out of seven late-treated infants developed severe BPD; one patient died as a consequence of cardiopulmonary deterioration. Two patients in the early treatment group died of nonpulmonary complications. We conclude that surfactant replacement therapy should probably be initiated as soon as possible after manifestation of severe RDS.
26例患有严重呼吸窘迫综合征（RDS）的早产儿在不同年龄接受了单剂量天然猪肺表面活性物质（固尔苏，200mg/kg）治疗。治疗标准包括严重RDS的临床和放射学征象（III-IV级）、需要人工通气以及吸入氧分数（FiO2）大于或等于0.6。19例新生儿接受了早期治疗（出生后2-15小时，平均出生体重标准差：1201±387g），7例患者接受了晚期治疗（出生后15小时以上至48小时，出生体重标准差1624±649g）。早期治疗患者治疗前的平均FiO2为0.88，晚期治疗患者为0.8，治疗时的年龄分别为4.6小时和36小时（中位数）。早期和晚期治疗的婴儿在开始治疗后5分钟内均表现出氧合改善（动脉血氧分压/吸入氧分数（PaO2/FiO2）比值增加两倍以上）。早期治疗组间歇性压力通气的平均持续时间为15天，晚期治疗组为19天。早期治疗的婴儿吸入氧浓度大于21%的总时长为21天，晚期治疗的婴儿为48天。所有患者均未发生气胸。所有早期治疗的婴儿均存活，且无严重支气管肺发育不良（BPD，吸入氧浓度大于21%，大于90天且有放射学改变）的迹象。然而，7例晚期治疗的婴儿中有2例发生了严重BPD；1例患者因心肺功能恶化死亡。早期治疗组有2例患者死于非肺部并发症。我们得出结论，严重RDS症状出现后应尽早开始表面活性物质替代治疗。
