Clyman R I, Jobe A, Heymann M, Ikegami M, Roman C, Payne B, Mauray F
J Pediatr. 1982 Jan;100(1):101-7. doi: 10.1016/s0022-3476(82)80247-3.
Instillation of surfactant into the trachea of preterm infants with respiratory distress syndrome is associated with a 90% incidence of patent ductus arteriosus. We studied the effects of surfactant therapy on the ductus arteriosus in 12 preterm lambs. Flow across the ductus arteriosus and systemic blood flow were calculated from radioactive microsphere injections. All developed respiratory failure (pH less than 7.1, Paco2 greater than 60) by 30 minutes after birth. Between 30 and 60 minutes after birth, six lambs were treated with tracheal instillation of 50 mg/kg surfactant lipid. By two hours after birth, treated lambs differed significantly from controls in pH (7.27 +0.02 vs 6.97 +0.08) and Paco2 (43.3 +4.1 vs 85 + 15). There were no differences in Pao2 or PGE2 concentrations or ductus arteriosus resistance, but there was a significantly larger shunt through the ductus arteriosus in treated lambs. This increased shunt resulted from the significant drop in pulmonary vascular resistance and not from a change in patency of the ductus arteriosus. Surfactant replacement may require interventions directed specifically at the patent ductus arteriosus in sick preterm infants.
给患有呼吸窘迫综合征的早产儿气管内滴注表面活性剂与动脉导管未闭发生率90%相关。我们研究了表面活性剂治疗对12只早产羔羊动脉导管的影响。通过放射性微球注射计算动脉导管血流和全身血流。所有羔羊在出生后30分钟内均出现呼吸衰竭（pH值小于7.1，动脉血二氧化碳分压大于60）。出生后30至60分钟之间，6只羔羊经气管滴注50mg/kg表面活性剂脂质进行治疗。出生后两小时，治疗组羔羊与对照组相比，pH值（7.27±0.02对6.97±0.08）和动脉血二氧化碳分压（43.3±4.1对85±15）有显著差异。动脉血氧分压、前列腺素E2浓度或动脉导管阻力无差异，但治疗组羔羊通过动脉导管的分流明显更大。这种分流增加是由于肺血管阻力显著下降，而非动脉导管通畅性改变所致。对于患病的早产儿，表面活性剂替代治疗可能需要针对动脉导管未闭进行专门干预。
