Milner A D
St. Thomas' Hospital, London, UK.
Turk J Pediatr. 1996 Jan-Mar;38(1):37-43.
Since the late 1950s it has been known that the cause of respiratory distress syndrome (RDS) is surfactant deficiency, especially in preterm infants. But surfactant protein B deficiency may cause RDS in term infants as well. Administration of natural surfactant produce is well known to a rapid improvement in oxygenation within 15 to 20 minutes. The effect of synthetic surfactant is less dramatic. Although randomized controlled trials have been done, the majority have been relatively small. Studies on the role of natural surfactant given to infants with established RDS (rescue therapy) have shown a reduction in the incidence of neonatal death and pneumothorax of 40% and 65%, respectively, compared to untreated infants. However, natural surfactant provides no apparent benefits in terms of the incidence of intraventricular hemorrhage (IVH), patent ductus arteriosus (PDA) or bronchopulmonary dysplasia (BPD). The results of synthetic surfactant given as rescue therapy have shown a similar effect with a 40% reduction in mortality and a 48% reduction in pneumothorax. However, synthetic surfactant also led to a 23% reduction in IVH, 27% in PDA, and 32% in BPD. When natural surfactant is given as prophylaxis (i.e. at or soon after birth, before the development of RDS), the reduction in mortality is 45% and the reduction in pneumothorax is 69%, but as with rescue therapy, there is no effect on the incidence of IVH or BPD. The effect on the incidence of PDA is an increase of 27%. When synthetic surfactants are given prophylactically, there is a similar reduction in mortality of 44% and a reduction in pneumothorax of 36%. The incidence of IVH and BPD is unchanged, but as with the natural surfactant, there is a small increase in the incidence of PDA of 27%. The main side effect is pulmonary hemorrhage that has been reported to occur in 4-7% of infants given surfactant. Although the administration of surfactant has had a dramatic effect on neonatal practice, it is likely that further studies will lead to more appropriate use of surfactant.
自20世纪50年代末以来，人们就知道呼吸窘迫综合征（RDS）的病因是表面活性剂缺乏，尤其是在早产儿中。但表面活性蛋白B缺乏也可能导致足月儿患RDS。众所周知，给予天然表面活性剂制剂后，氧合作用会在15至20分钟内迅速改善。合成表面活性剂的效果则没那么显著。尽管已经进行了随机对照试验，但大多数试验规模相对较小。对已患RDS的婴儿给予天然表面活性剂（挽救治疗）的作用研究表明，与未治疗的婴儿相比，新生儿死亡和气胸的发生率分别降低了40%和65%。然而，天然表面活性剂在脑室内出血（IVH）、动脉导管未闭（PDA）或支气管肺发育不良（BPD）的发生率方面没有明显益处。作为挽救治疗给予合成表面活性剂的结果显示了类似的效果，死亡率降低了40%，气胸降低了48%。然而，合成表面活性剂也导致IVH降低了23%，PDA降低了27%，BPD降低了32%。当给予天然表面活性剂进行预防（即在出生时或出生后不久，在RDS发生之前）时，死亡率降低45%，气胸降低69%，但与挽救治疗一样，对IVH或BPD的发生率没有影响。对PDA发生率的影响是增加了27%。当给予合成表面活性剂进行预防时，死亡率有类似的降低，为44%，气胸降低36%。IVH和BPD的发生率没有变化，但与天然表面活性剂一样，PDA的发生率有小幅增加，为27%。主要副作用是肺出血，据报道，接受表面活性剂治疗的婴儿中有4 - 7%发生肺出血。尽管表面活性剂的应用对新生儿治疗产生了巨大影响，但进一步的研究可能会使表面活性剂得到更恰当的使用。
