Abbasi S, Bhutani V K, Gerdes J S
Neonatal Pulmonary Laboratory, Pennsylvania Hospital, Philadelphia 19107.
J Pediatr. 1993 Mar;122(3):446-52. doi: 10.1016/s0022-3476(05)83439-0.
The pulmonary outcome for preterm infants 1 year after synthetic surfactant replacement for respiratory distress syndrome was assessed by examining their pulmonary status and the results of pulmonary function tests. A total of 47 infants were followed: 13 infants mean +/- SD: birth weight, 1960 +/- 616 gm; gestation, 32 +/- 1.1 weeks) had been assigned to the placebo group and 34 (birth weight = 1890 +/- 530 gm; gestation = 32 +/- 2.5 weeks) to surfactant treatment. The infants were examined at 3 to 6 months of age (n = 45) and at 9 to 12 months of age (n = 36). There were no significant differences between the two groups in predisposing clinical conditions that would lead to chronic lung disease. The infants had similar patterns of growth, respiratory-related illness, and need for theophylline therapy, diuretic therapy, or both. None had hypoxemia by pulse oximetry. Mean (+/- SEM) values for pulmonary mechanics and energetics in surfactant-treated infants were significantly (p < 0.01) lower for total pulmonary resistance in late infancy (57.7 +/- 11.7 vs 35.3 +/- 4.6 cm H2O/L per second). Lower values (mean +/- SEM) of resistive work of breathing were also measured in the surfactant-treated group (60.7 +/- 12.0 vs 38.2 +/- 3.6 gm-cm/kg per breath). The dynamic pulmonary compliance values were in the low-normal range for both groups, and the mean (+/- SEM) peak-to-peak esophageal pressure values were elevated (11.47 +/- 2.26 cm H2O in the placebo group; 9.24 +/- 0.69 cm H2O in the surfactant group). Forced expiratory flow measurements in late infancy demonstrated significant (p < 0.01) improvement in expiratory reserves and reduced evidence of airflow obstruction in the surfactant-treated infants (peak flow (mean +/- SEM): 287.1 +/- 69 vs 396.9 +/- 27 ml/sec; forced expiratory flow (mean +/- SEM) at functional residual capacity: 56.3 +/- 7.5 vs 83.4 +/- 19.5 ml/sec). No significant differences in pulmonary functions were noted in early infancy. These data suggest that surfactant replacement for respiratory distress syndrome may be associated with beneficial long-term effects on the resistive airflow properties of larger preterm infants.
通过检查早产婴儿的肺部状况和肺功能测试结果，评估了其在接受合成表面活性剂替代治疗呼吸窘迫综合征1年后的肺部转归。共对47名婴儿进行了随访：13名婴儿（平均±标准差：出生体重1960±616克；孕周32±1.1周）被分配到安慰剂组，34名婴儿（出生体重=1890±530克；孕周=32±2.5周）接受表面活性剂治疗。在3至6个月龄时检查了45名婴儿，在9至12个月龄时检查了36名婴儿。两组在导致慢性肺病的易感临床情况方面无显著差异。婴儿在生长模式、与呼吸相关的疾病以及对茶碱治疗、利尿剂治疗或两者的需求方面相似。通过脉搏血氧饱和度测定法均未发现低氧血症。表面活性剂治疗组婴儿在婴儿后期的肺力学和能量学平均（±标准误）值显示，总肺阻力显著降低（p<0.01）（57.7±11.7对比35.3±4.6厘米水柱/升每秒）。表面活性剂治疗组的呼吸阻力功值（平均±标准误）也较低（60.7±12.0对比38.2±3.6克-厘米/千克每次呼吸）。两组的动态肺顺应性值均处于低正常范围，平均（±标准误）峰-峰食管压力值升高（安慰剂组为11.47±2.26厘米水柱；表面活性剂组为9.24±0.69厘米水柱）。婴儿后期的用力呼气流量测量显示，表面活性剂治疗组的呼气储备有显著改善（p<0.01），气流阻塞的证据减少（峰值流量（平均±标准误）：287.1±69对比396.9±27毫升/秒；功能残气量时的用力呼气流量（平均±标准误）：56.3±7.5对比83.4±19.5毫升/秒）。婴儿早期未发现肺功能有显著差异。这些数据表明，表面活性剂替代治疗呼吸窘迫综合征可能对较大早产婴儿的气流阻力特性有长期有益影响。
