Chan J O, Moglia B A, Reeves I V, Kim A H, Darrow K A, Seaton J F, Marks K H
Department of Pediatrics, Pennsylvania State University Children's Hospital, College of Medicine, Milton S. Hershey Medical Center, Hershey 17033.
Pediatr Pulmonol. 1994 Apr;17(4):246-9. doi: 10.1002/ppul.1950170408.
Our hypothesis was that surfactant instilled into the trachea, followed by body positioning maneuvers utilized to enhance drug distribution, could alter hemodynamic function and stimulate the release of catecholamines. We conducted a prospective randomized study designed to compare the immediate physiologic effects of the first dose of Exosurf Neonatal (5 mL/kg; n = 16) or Survanta (4 mL/kg; n = 18), when surfactant administration was standardized with strict adherence to drug company protocol. Physiologic variables were monitored continuously. Arterial blood gases (ABG) and plasma catecholamine concentrations were measured before, and 5 minutes after, surfactant administration. Both surfactants had an immediate effect on arterial oxygen saturation (SaO2), partial pressure of oxygen in arterial blood (PaO2), and oxygen index (OI). The improvement in oxygenation after surfactant therapy was similar in both groups. There was no significant difference in the mean umbilical arterial blood pressure (ABP) following surfactant therapy in both groups. High concentrations of plasma norepinephrine (reflecting activity of the sympathetic nerves) and epinephrine (a measure of secretion from the adrenal medulla) indicate that preterm infants with respiratory distress syndrome (RDS) prior to treatment mount a substantial stress response. The currently recommended techniques for instillation of surfactant appear not to trigger a significant further surge of plasma catecholamines or to acutely change mean ABP. Alternatively, it may be possible that the lack of response was because catecholamine release was already maximal.
我们的假设是，将表面活性剂滴入气管，随后采取体位调整动作以促进药物分布，这可能会改变血流动力学功能并刺激儿茶酚胺的释放。我们进行了一项前瞻性随机研究，旨在比较当严格按照药品公司方案标准化给予表面活性剂时，首剂Exosurf Neonatal（5 mL/kg；n = 16）或Survanta（4 mL/kg；n = 18）的即时生理效应。持续监测生理变量。在给予表面活性剂之前和之后5分钟测量动脉血气（ABG）和血浆儿茶酚胺浓度。两种表面活性剂均对动脉血氧饱和度（SaO2）、动脉血氧分压（PaO2）和氧合指数（OI）有即时影响。两组在表面活性剂治疗后的氧合改善情况相似。两组在表面活性剂治疗后的平均脐动脉血压（ABP）无显著差异。高浓度的血浆去甲肾上腺素（反映交感神经活动）和肾上腺素（衡量肾上腺髓质分泌的指标）表明，治疗前患有呼吸窘迫综合征（RDS）的早产儿会产生显著的应激反应。目前推荐的表面活性剂滴注技术似乎不会引发血浆儿茶酚胺的显著进一步激增，也不会急性改变平均ABP。或者，可能是缺乏反应是因为儿茶酚胺释放已经达到最大值。
