Alba J, Agarwal R, Hegyi T, Hiatt I M
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical Center, New Brunswick, USA.
Pediatr Pulmonol. 1995 Sep;20(3):172-6. doi: 10.1002/ppul.1950200308.
Surfactant rescue therapy can be utilized effectively early in the course of respiratory distress syndrome (RDS) in infants weighing > 1,000 g and treated exclusively with continuous positive airway pressure (CPAP) therapy. Thirteen infants (BW, 1,774 +/- 580 g; GA, 31 +/- 3 weeks) comprising the CPAP/SURFACTANT group were compared with 12 infants (BW, 1,753 +/- 556 g; GA, 31 +/- 2 weeks) who comprised the intermittent mandatory ventilation (IMV)/surfactant group, and with 14 infants (BW, 1,776 +/- 332 g; GA, 32 +/- 2 weeks) treated with CPAP before surfactant was clinically available. A 5 mL/kg dose of Exosurf Neonatal (Burroughs-Wellcome) was administered to infants intratracheally when the FiO2 requirement reached 0.40 to maintain the PO2 above 50 torr. Infants in the CPAP/surfactant group were intubated solely for surfactant administration and extubated within 18 +/- 6 min of treatment. The CPAP/surfactant group was treated at a mean age of 12.3 +/- 9.3 h, and the IMV/surfactant group at 10.2 +/- 9.8 h. Alveolar-arterial oxygen gradient (AaDO2), oxygenation index (OI), and mean airway pressure (MAP) were determined immediately before and after surfactant therapy, and at comparable times for the CPAP-only group. A significant difference was found in pre-treatment AaDO2, OI and MAP between the CPAP/surfactant group and IMV/surfactant group, but not between the CPAP/surfactant group and the CPAP-only group. Similarly, a significant difference in AaDO2, OI and MAP continued post-treatment was noted. However, a significant difference was also found at this time between the CPAP/surfactant group and the CPAP-only group. In addition, a significant difference was noted in AaDO2 and OI pre- and post-treatment within each surfactant-treated group. Furthermore, in the CPAP-only group AaDO2 and OI actually worsened (212 +/- 70 vs. 239 +/- 68; 4.0 +/- 1 vs. 4.5 +/- 2, respectively). There was a significant reduction in the duration of oxygen therapy (3 +/- 2 vs. 5 +/- 2 vs. 4.5 +/- 2 days, respectively) as well as in the total days of hospitalization (30 +/- 10 vs. 42 +/- 15 vs. 43 +/- 12 days, respectively). We conclude that in this small group of infants surfactant administration was effective and safe. It appeared to improve the course of RDS and shorten the duration of oxygen exposure and days of hospitalization.
对于体重超过1000克且仅接受持续气道正压通气（CPAP）治疗的婴儿，表面活性剂挽救疗法可在呼吸窘迫综合征（RDS）病程早期有效应用。将13例婴儿（体重1774±580克；胎龄31±3周）组成的CPAP/表面活性剂组与12例婴儿（体重1753±556克；胎龄31±2周）组成的间歇强制通气（IMV）/表面活性剂组，以及14例在临床可获得表面活性剂之前接受CPAP治疗的婴儿（体重1776±332克；胎龄32±2周）进行比较。当吸入氧分数（FiO2）需求达到0.40以维持动脉血氧分压（PO2）高于50托时，给婴儿气管内注入5毫升/千克剂量的Exosurf Neonatal（百时美施贵宝公司）。CPAP/表面活性剂组的婴儿仅为注入表面活性剂而插管，并在治疗后18±6分钟内拔管。CPAP/表面活性剂组的平均治疗年龄为12.3±9.3小时，IMV/表面活性剂组为10.2±9.8小时。在表面活性剂治疗前后以及CPAP单独治疗组的相应时间点测定肺泡-动脉氧分压差（AaDO2）、氧合指数（OI）和平均气道压（MAP）。发现CPAP/表面活性剂组与IMV/表面活性剂组治疗前的AaDO2、OI和MAP有显著差异，但CPAP/表面活性剂组与仅接受CPAP治疗组之间无显著差异。同样，治疗后AaDO2、OI和MAP也存在显著差异。然而，此时CPAP/表面活性剂组与仅接受CPAP治疗组之间也存在显著差异。此外，每个表面活性剂治疗组治疗前后的AaDO2和OI也存在显著差异。而且，仅接受CPAP治疗组的AaDO2和OI实际上恶化了（分别为212±70与239±68；4.0±1与4.5±2）。氧疗持续时间（分别为3±2天、5±2天、4.5±2天）以及住院总天数（分别为30±10天、42±15天、43±12天）均显著减少。我们得出结论，在这一小群婴儿中，注入表面活性剂是有效且安全的。它似乎改善了RDS的病程，缩短了吸氧时间和住院天数。
