Suske G, Oestreich K, Varnholt V, Lasch P, Kachel W
University Children's Hospital, Mannheim, Germany.
Acta Paediatr. 1996 Jun;85(6):713-8. doi: 10.1111/j.1651-2227.1996.tb14132.x.
We examined 26 preterm infants with respiratory distress syndrome in a randomized controlled prospective study to determine whether early postnatal dexamethasone therapy (< 2 h; 0.5 mg/kg per day) over 5 days in addition to substitution of surfactant (100 mg/kg) facilitates extubation and the course of RDS. Control (n = 12) and treated (n = 14) groups were comparable in birthweight (mean +/- SD: 1219 +/- 292 versus 1446 +/- 442 g), gestational age (29.3 +/- 2.2 versus 30.6 +/- 2.7 weeks), prenatal characteristics and initial respiratory and blood gas parameters. In both groups one infant died. Infants in the dexamethasone group responded better to surfactant (12/14 versus 3/12; p < 0.01), were extubated earlier (6.6 versus 14.2 days; p < 0.02) and required less time on supplemental oxygen (4.2 versus 12.5 days; p < 0.02). Pulmonary complications tended to be lower in the dexamethasone group (1/14 versus 4/12), as was the frequency of retinopathy (2/14 versus 6/12; p < 0.05). We conclude that early postnatal dexamethasone therapy improves response to surfactant therapy resulting in better weaning and earlier extubation in premature infants.
我们在一项随机对照前瞻性研究中检查了26例患有呼吸窘迫综合征的早产儿，以确定出生后早期（<2小时；每天0.5mg/kg）地塞米松治疗5天，除了使用表面活性剂（100mg/kg）替代之外，是否有助于拔管和呼吸窘迫综合征的病程。对照组（n = 12）和治疗组（n = 14）在出生体重（均值±标准差：1219±292对1446±442g）、胎龄（29.3±2.2对30.6±2.7周）、产前特征以及初始呼吸和血气参数方面具有可比性。两组各有1例婴儿死亡。地塞米松组的婴儿对表面活性剂反应更好（12/14对3/12；p<0.01），拔管更早（6.6天对14.2天；p<0.02），且需要补充氧气的时间更短（4.2天对12.5天；p<0.02）。地塞米松组的肺部并发症倾向于更低（1/14对4/12），视网膜病变的发生率也是如此（2/14对6/12；p<0.05）。我们得出结论，出生后早期地塞米松治疗可改善对表面活性剂治疗的反应，从而使早产儿撤机更好且拔管更早。
