Dunn M S, Shennan A T, Possmayer F
Regional Perinatal Unit, Women's College Hospital, Toronto, Ontario, Canada.
Pediatrics. 1990 Oct;86(4):564-71.
To assess the efficacy of a multiple-dose protocol of surfactant replacement therapy in neonates of 30 to 36 weeks' gestation, 75 neonates were randomly assigned to control, single-dose surfactant, or multiple-dose surfactant groups. Neonates at less than 6 hours of age with a diagnosis of respiratory distress syndrome were eligible. Subjects were randomly assigned to receive either 100 mg/kg of bovine surfactant or air placebo. Neonates in the multiple-dose group were eligible to receive up to three additional doses as indicated. Neonates in both surfactant groups showed a positive response to treatment, with marked improvement in oxygenation by 10 minutes postinstillation (P less than .0001). Both surfactant groups had better oxygenation than control subjects at lower ventilatory parameters over the first 24 hours. A deterioration in oxygenation and ventilatory requirements was seen in both treatment groups starting 6 to 12 hours after the first dose. The deterioration in oxygenation could be minimized by the use of multiple doses; however, extra doses had no effect on diminishing ventilatory requirements or time to extubation. It is concluded that surfactant therapy at less than 6 hours of age is effective in acutely reducing oxygen and ventilatory requirements in neonates of 30 to 36 weeks' gestation with respiratory distress syndrome. It appears that multiple doses of surfactant have a greater effect on sustaining improvements in oxygenation than on ventilatory requirements. Further study is required to determine optimal dosage and retreatment strategy.
为评估多剂量表面活性剂替代疗法对孕周为30至36周的新生儿的疗效，75例新生儿被随机分为对照组、单剂量表面活性剂组或多剂量表面活性剂组。诊断为呼吸窘迫综合征且年龄小于6小时的新生儿符合入选标准。受试者被随机分配接受100mg/kg的牛肺表面活性剂或空气安慰剂。多剂量组的新生儿在有指征时可额外接受多达三剂治疗。两个表面活性剂组的新生儿对治疗均呈现阳性反应，在滴注后10分钟时氧合情况有显著改善（P<0.0001）。在最初24小时内，两个表面活性剂组在较低通气参数下的氧合情况均优于对照组。在首次给药后6至12小时开始，两个治疗组均出现氧合及通气需求的恶化。使用多剂量可将氧合恶化情况降至最低；然而，额外剂量对减少通气需求或拔管时间并无影响。得出结论，对于孕周为30至36周且患有呼吸窘迫综合征的新生儿，在出生6小时内进行表面活性剂治疗可有效急性降低其氧气及通气需求。多剂量表面活性剂似乎对维持氧合改善的作用比对通气需求的作用更大。需要进一步研究以确定最佳剂量及再治疗策略。
