Zekai Tahir Burak Kadin Sagligi Egitim ve Arastirma Hastanesi, Talatpasa Bulvari, Samanpazari, Ankara; Turkey 06230.
Pediatrics. 2013 Feb;131(2):e502-9. doi: 10.1542/peds.2012-0603. Epub 2013 Jan 28.
The primary aim of this randomized study was to describe the feasibility of early administration of surfactant via a thin catheter during spontaneous breathing (Take Care) and compare early mechanical ventilation (MV) requirement with the InSurE (Intubate, Surfactant, Extubate) procedure.
Preterm infants, who were <32 weeks and stabilized with nasal continuous positive airway pressure (nCPAP) in the delivery room, were randomized to receive early surfactant treatment either by the Take Care or InSurE technique. Tracheal instillation of 100 mg/kg poractant α via 5-F catheter during spontaneous breathing under nCPAP was performed in the intervention group. In the InSurE procedure, infants were intubated, received positive pressure ventilation for 30 seconds after surfactant instillation, and placed on nCPAP immediately.
One hundred infants in each group were analyzed. The MV requirement in the first 72 hours of life was significantly lower in the Take Care group when compared with the InSurE group (30% vs 45%, P = .02, odds ratio -0.52, 95% confidence interval -0.94 to -0.29). Mean duration of both nCPAP and MV were significantly shorter in the Take Care group (P values .006 and .002, respectively). Bronchopulmonary dysplasia rate was significantly lower among the infants treated with the Take Care technique (relative risk -0.27, 95% confidence interval -0.1 to -0.72)
The Take Care technique is feasible for the treatment of respiratory distress syndrome in infants with very low birth weight. It significantly reduces both the need and duration of MV, and thus the bronchopulmonary dysplasia rate in preterm infants.
本随机研究的主要目的是描述在自主呼吸时通过细导管早期给予表面活性剂（Take Care）的可行性，并比较早期机械通气（MV）的需求与 InSurE（插管、表面活性剂、拔管）程序。
将在产房接受经鼻持续气道正压通气（nCPAP）稳定的极早产儿随机分为接受 Take Care 或 InSurE 技术的早期表面活性剂治疗。干预组在 nCPAP 下自主呼吸时通过 5-F 导管给予 100mg/kg 猪肺磷脂α。在 InSurE 程序中，婴儿插管，在表面活性剂注入后接受正压通气 30 秒，然后立即置于 nCPAP 上。
每组 100 例婴儿进行分析。与 InSurE 组相比，Take Care 组在生命的前 72 小时内的 MV 需求显著降低（30%对 45%，P=0.02，比值比-0.52，95%置信区间-0.94 至-0.29）。Take Care 组的 nCPAP 和 MV 的平均持续时间均显著缩短（P 值分别为<.006 和<.002）。接受 Take Care 技术治疗的婴儿支气管肺发育不良的发生率显著降低（相对风险-0.27，95%置信区间-0.1 至-0.72）。
Take Care 技术对于极低出生体重儿呼吸窘迫综合征的治疗是可行的。它显著降低了 MV 的需求和持续时间，从而降低了早产儿支气管肺发育不良的发生率。
