LeVine A M, Lotze A, Stanley S, Stroud C, O'Donnell R, Whitsett J, Pollack M M
Section of Critical Care Medicine, Children's National Medical Center, Washington, DC, USA.
Crit Care Med. 1996 Jun;24(6):1062-7. doi: 10.1097/00003246-199606000-00029.
To determine surfactant profiles of tracheal secretions in mechanically ventilated children with respiratory failure secondary to bacterial pneumonia, viral pneumonitis, adult respiratory distress syndrome (ARDS), and cardiopulmonary bypass.
Prospective, cohort study.
Tertiary, multidisciplinary, pediatric intensive care unit.
One hundred twenty pediatric patients with respiratory failure requiring mechanical ventilation.
Routine tracheal aspirates were collected from children with bacterial pneumonia, viral pneumonitis, ARDS, postcardiopulmonary bypass, and a postsurgical control group. Samples were obtained on days 1, 2, 3, after every week of intubation and on the day of extubation.
The tracheal aspirates were analyzed by high-performance liquid chromatography for lecithin/sphingomyelin rations and by enzyme-linked immunosorbent assay for surfactant proteins A and B. Lung compliance and the oxygenation index were measured on each day of sample collection. On day 1, patients with bacterial pneumonia, viral pneumonitis, and ARDS had decreased lecithin/sphingomyelin ration (p < .001), and those patients with bacterial pneumonia and viral pneumonitis had decreased surfactant protein A/protein concentration (p < .001). The lecithin/sphingomyelin ratios and surfactant protein A/protein concentration were significantly different among the groups (p < .001), with the bacterial pneumonia and viral pneumonitis groups having higher lecithin/sphingomyelin ratios and increased surfactant protein concentrations before extubation. Pulmonary compliance was lower and the oxygenation index was higher than controls (p < .001) in patients with bacterial pneumonia, viral pneumonitis, and ARDS. Pulmonary compliance was correlated weakly with lecithin/sphingomyelin ratio (r2 = .11, p < .001) and surfactant protein A/protein concentration (r2 = .03, p < .05). Surfactant protein B was similar in the diagnostic groups. Surfactant content in tracheal secretions from cardiopulmonary bypass patients was equivalent to controls.
Abnormal tracheal aspirate surfactant phospholipids and surfactant protein A were noted in children with bacterial pneumonia, viral pneumonitis, and ARDS, but not in children on cardiopulmonary bypass.
确定继发于细菌性肺炎、病毒性肺炎、成人呼吸窘迫综合征（ARDS）和体外循环的呼吸衰竭的机械通气儿童气管分泌物中的表面活性剂谱。
前瞻性队列研究。
三级多学科儿科重症监护病房。
120例需要机械通气的呼吸衰竭儿科患者。
从患有细菌性肺炎、病毒性肺炎、ARDS、体外循环术后的儿童以及术后对照组收集常规气管吸出物。在插管后的第1天、第2天、第3天、每周后以及拔管当天采集样本。
通过高效液相色谱法分析气管吸出物中的卵磷脂/鞘磷脂比值，通过酶联免疫吸附测定法分析表面活性剂蛋白A和B。在采集样本的每一天测量肺顺应性和氧合指数。第1天，患有细菌性肺炎、病毒性肺炎和ARDS的患者卵磷脂/鞘磷脂比值降低（p < .001），患有细菌性肺炎和病毒性肺炎的患者表面活性剂蛋白A/蛋白浓度降低（p < .001）。各组之间卵磷脂/鞘磷脂比值和表面活性剂蛋白A/蛋白浓度存在显著差异（p < .001），细菌性肺炎和病毒性肺炎组在拔管前卵磷脂/鞘磷脂比值更高且表面活性剂蛋白浓度增加。细菌性肺炎、病毒性肺炎和ARDS患者的肺顺应性低于对照组，氧合指数高于对照组（p < .001）。肺顺应性与卵磷脂/鞘磷脂比值（r2 = .11，p < .001）和表面活性剂蛋白A/蛋白浓度（r2 = .03，p < .05）弱相关。表面活性剂蛋白B在各诊断组中相似。体外循环患者气管分泌物中的表面活性剂含量与对照组相当。
在患有细菌性肺炎、病毒性肺炎和ARDS的儿童中发现气管吸出物表面活性剂磷脂和表面活性剂蛋白A异常，但体外循环儿童未出现异常。
