Robertson B
Department of Pathology, St. Görons Hospital, Stockholm, Sweden.
Eur J Respir Dis Suppl. 1987;153:242-8.
Several recent reports have documented the efficacy of surfactants replacement therapy in the neonatal respiratory distress syndrome (RDS). The surfactants tested in these trials were obtained from animal lungs or human amniotic fluid. In general, such natural preparations seem to be superior to entirely synthetic surfactants, although promising results have recently been obtained in animal experiments with artificial surfactant based on isolated apoproteins and synthetic phospholipids. Furthermore, surfactant replacement therapy seems to be more effective when the exogenous material is administered at birth, before the first breath, than when surfactant is instilled into the airways after a period of ventilation. This discrepancy may be due to maldistribution of the exogenous material, or to the rapid development of epithelial lesions in the immature lung, with leakage of surfactant-inhibiting proteins into the airspaces. A transient beneficial response to surfactant replacement may also be due to circulatory problems, especially reversal of the shunt through a patent ductus arteriosus, with overloading of the lung circulation leading to pulmonary oedema and recurrent respiratory failure. Additional, properly randomized clinical trials are required to evaluate the benefits and potential hazards of surfactant replacement therapy in neonatal RDS.
最近的几份报告记录了表面活性剂替代疗法在新生儿呼吸窘迫综合征（RDS）中的疗效。这些试验中所测试的表面活性剂取自动物肺脏或人类羊水。总体而言，这类天然制剂似乎优于完全合成的表面活性剂，尽管最近在基于分离载脂蛋白和合成磷脂的人工表面活性剂的动物实验中取得了令人鼓舞的结果。此外，在外源性物质于出生时、首次呼吸之前给药时，表面活性剂替代疗法似乎比在通气一段时间后将表面活性剂滴入气道时更有效。这种差异可能是由于外源性物质分布不均，或者是由于未成熟肺中上皮病变的迅速发展，导致表面活性剂抑制蛋白漏入气腔。对表面活性剂替代疗法的短暂有益反应也可能归因于循环问题，尤其是通过动脉导管未闭的分流逆转，肺循环超负荷导致肺水肿和反复呼吸衰竭。还需要进行更多适当的随机临床试验，以评估表面活性剂替代疗法在新生儿RDS中的益处和潜在危害。
