Boet A, Brat R, Aguilera S S, Tissieres P, De Luca D
Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals - APHP, "A. Beclere" Medical Center, Paris, France -
Minerva Anestesiol. 2014 Dec;80(12):1345-56. Epub 2014 Feb 7.
Surfactant is a cornerstone of neonatal critical care for the treatment of respiratory distress syndrome of preterm babies. However, other indications have been studied for various clinical conditions both in term neonates and in children beyond neonatal age. A high degree of evidence is not yet available in some cases and this is due to the complex and not yet totally understood physiopathology of the different types of pediatric and neonatal lung injury. We here summarise the state of the art of the bench and bedside knowledge about surfactant use for the respiratory conditions usually cared for in neonatal and pediatric intensive care units. Future research direction will also be presented. On the whole, surfactant is able to improve oxygenation in infection related respiratory failure, pulmonary hemorrhage and meconium aspiration syndrome. Bronchoalveolar lavage with surfactant solution is currently the only means to reduce mortality or need for extracorporeal life support in neonates with meconium aspiration. While surfactant bolus or lavage only improves the oxygenation and ventilatory requirements in other types of postneonatal acute respiratory distress syndrome (ARDS), there seems to be a reduction in the mortality of small infants with RSV-related ARDS.
表面活性剂是新生儿重症监护中治疗早产儿呼吸窘迫综合征的基石。然而，对于足月儿和新生儿期后的儿童的各种临床情况，也对表面活性剂的其他适应症进行了研究。在某些情况下，尚未获得高度的证据，这是由于不同类型的儿科和新生儿肺损伤的生理病理学复杂且尚未完全了解。我们在此总结了关于表面活性剂用于新生儿和儿科重症监护病房通常治疗的呼吸疾病的基础研究和临床知识的现状。还将介绍未来的研究方向。总体而言，表面活性剂能够改善感染相关呼吸衰竭（IRF）、肺出血和胎粪吸入综合征中的氧合。用表面活性剂溶液进行支气管肺泡灌洗是目前降低胎粪吸入新生儿死亡率或体外生命支持需求的唯一方法。虽然表面活性剂推注或灌洗仅改善其他类型的新生儿期后急性呼吸窘迫综合征（ARDS）中的氧合和通气需求，但呼吸道合胞病毒（RSV）相关ARDS的小婴儿死亡率似乎有所降低。
