Speer C P, Gefeller O, Groneck P, Laufkötter E, Roll C, Hanssler L, Harms K, Herting E, Boenisch H, Windeler J
Department of Paediatrics, University of Göttingen, Germany.
Arch Dis Child Fetal Neonatal Ed. 1995 Jan;72(1):F8-13. doi: 10.1136/fn.72.1.f8.
To compare treatment regimens of two widely used natural surfactant preparations Curosurf and Survanta in respiratory distress syndrome (RDS).
The effects of the two treatment regimens on gas exchange, ventilatory requirements, and 28 day outcome in infants with RDS were compared. Seventy five preterm infants (birth weight 700-1500 g) with RDS requiring artificial ventilation with an FIO2 of > or = 0.4, were randomly selected at 1-24 hours of age. One group received an initial dose of Curosurf (200 mg/kg); the other group Survanta (100 mg/kg). Patients who remained dependent on artificial ventilation with an FIO2 of > or = 0.3 received up to two additional doses of Curosurf (each of 100 mg/kg) after 12 and 24 hours or up to three additional doses of Survanta (each of 100 mg/kg) between six and 48 hours after the initial dose.
There was a rapid improvement in oxygenation and ventilatory requirements were reduced in both groups. However, infants treated with Curosurf had a higher arterial:alveolar oxygen tension ratio and required a lower peak inspiratory pressure and mean airway pressure at several time points within 24 hours of randomisation (p < 0.05-0.001). The incidences of pneumothorax in the Curosurf and Survanta groups were 6% and 12.5%, respectively; the corresponding figures for grades 3-4 intracerebral haemorrhage were 3% and 12.5%, respectively. Mortality was 3% in the Curosurf group and 12.5% in the Survanta group. However, these differences did not reach significance.
The Curosurf treatment regimen resulted in a more rapid improvement in oxygenation than Survanta and reduced ventilatory requirements up to 24 hours after start of treatment. This was associated with a trend towards reduced incidence of serious pulmonary and non-pulmonary complications.
比较两种广泛使用的天然表面活性剂制剂珂立苏（Curosurf）和固尔苏（Survanta）在呼吸窘迫综合征（RDS）中的治疗方案。
比较两种治疗方案对RDS患儿气体交换、通气需求及28天预后的影响。75例出生体重700 - 1500g、RDS需要人工通气且吸入氧分数（FIO2）≥0.4的早产儿在出生1 - 24小时被随机选取。一组接受初始剂量的珂立苏（200mg/kg）；另一组接受固尔苏（100mg/kg）。仍依赖FIO2≥0.3人工通气的患者在12和24小时后接受额外最多两剂珂立苏（各100mg/kg），或在初始剂量后6至48小时接受额外最多三剂固尔苏（各100mg/kg）。
两组氧合均迅速改善，通气需求降低。然而，接受珂立苏治疗的婴儿在随机分组后24小时内的几个时间点动脉血氧分压与肺泡氧分压比值更高，所需吸气峰压和平均气道压更低（p < 0.05 - 0.001）。珂立苏组和气胸发生率分别为6%和12.5%；相应的3 - 4级脑室内出血发生率分别为3%和12.5%。珂立苏组死亡率为3%，固尔苏组为12.5%。然而，这些差异无统计学意义。
珂立苏治疗方案比固尔苏能使氧合更快改善，并在治疗开始后24小时内降低通气需求。这与严重肺部和非肺部并发症发生率降低的趋势相关。
