Halliday H L, Speer C P, Robertson B
Royal Maternity Hospital, Belfast, Northern Ireland.
Eur J Pediatr. 1996 Dec;155(12):1047-51. doi: 10.1007/BF02532529.
This study is based on clinical data from a retrospective series of 54 infants with meconium aspiration syndrome treated with porcine surfactant at a median age of 14 h (range 1-176 h). Median arterial/ alveolar oxygen tension ratio (a/A PO2 ratio) before treatment was 0.08 (range 0.02-0.23) and oxygenation index 25 (range 6-110). After treatment with surfactant at an initial dose of 50-200 mg/kg there was a modest but statistically significant increase in a/APO2 ratio associated with a reduction of oxygenation index. Ten (18%) babies showed a 3-4 fold increase in a/APO2 ratio within 1-2 h of treatment. Twenty-four (44%) babies showed little or no response by 1-2 h with the remaining infants showing modest improvement in oxygenation. One third of babies required repeated doses of surfactant. Twenty-eight day survival was 81%, with two babies requiring extracorporeal membrane oxygenation.
Natural surfactant treatment of severe meconium aspiration may prove to be a useful intervention and randomised controlled clinical trials should be undertaken.
本研究基于对54例胎粪吸入综合征婴儿的回顾性系列临床数据，这些婴儿接受了猪肺表面活性物质治疗，中位年龄为14小时（范围1 - 176小时）。治疗前动脉/肺泡氧分压比值（a/A PO2比值）中位数为0.08（范围0.02 - 0.23），氧合指数为25（范围6 - 110）。在初始剂量为50 - 200mg/kg的肺表面活性物质治疗后，a/APO2比值有适度但具有统计学意义的增加，同时氧合指数降低。10例（18%）婴儿在治疗1 - 2小时内a/APO2比值增加3 - 4倍。24例（44%）婴儿在1 - 2小时内几乎没有反应，其余婴儿氧合有适度改善。三分之一的婴儿需要重复使用肺表面活性物质。28天生存率为81%，有2例婴儿需要体外膜肺氧合。
天然肺表面活性物质治疗重度胎粪吸入可能是一种有用的干预措施，应进行随机对照临床试验。
