Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
J Trop Pediatr. 2019 Oct 1;65(5):491-497. doi: 10.1093/tropej/fmy081.
To compare the effectiveness of lung lavage with surfactant vs. bolus surfactant treatment in meconium aspiration syndrome (MAS).
This randomized controlled trial included newborns ventilated with MAS. In lavage group (n = 17) 30 ml/kg of diluted porcine surfactant was instilled into the lung. In bolus group (n = 16) porcine surfactant (100 mg/kg) was administered as bolus. Respiratory outcomes and mortality were compared between groups.
Duration of respiratory support was found to be similar between lavage and bolus groups (3 vs. 3.5 days, p = 0.36). Death or requirement for extracorporeal membrane oxygenation (ECMO) was 12% vs. 6%; respectively (RR: 2, 95% CI 0.16-24.48; p = 1.0). Duration of oxygen therapy, high-frequency ventilation or inhaled nitric oxide requirement did not differ among the groups.
Lung lavage did not show any advantage over bolus therapy on duration of respiratory support. The incidence of pneumothorax and surfactant re-administration decreased nonsignificantly in lavage group.
We registered the trial to ClinicalTrials.gov (http://clinicaltrials.gov) under identifier NCT02041546.
Lung Lavage With Dilute Poractant Alfa for Meconium Aspiration Syndrome.
比较肺灌洗联合表面活性物质与单次推注表面活性物质治疗胎粪吸入综合征（MAS）的效果。
本随机对照试验纳入了接受 MAS 通气治疗的新生儿。在灌洗组（n=17）中，将 30ml/kg 的稀释猪肺表面活性剂注入肺部。在推注组（n=16）中，给予 100mg/kg 的猪肺表面活性剂作为推注。比较两组的呼吸结局和死亡率。
灌洗组和推注组的呼吸支持时间相似（3 天 vs. 3.5 天，p=0.36）。死亡或需要体外膜肺氧合（ECMO）的比例分别为 12%和 6%（RR：2，95%CI 0.16-24.48；p=1.0）。两组间氧疗、高频通气或吸入一氧化氮的需求持续时间无差异。
肺灌洗在呼吸支持时间上并未显示优于单次推注治疗。灌洗组气胸和再次给予表面活性物质的发生率略有下降，但无统计学意义。
我们在 ClinicalTrials.gov（http://clinicaltrials.gov）上注册了这项试验，注册号为 NCT02041546。
肺灌洗联合稀释猪肺表面活性剂治疗胎粪吸入综合征。
