Nicholas T E, Doyle I R, Bersten A D
Department of Human Physiology, School of Medicine, Flinders University, Adelaide, Australia.
Thorax. 1997 Feb;52(2):195-7. doi: 10.1136/thx.52.2.195.
Although one would predict that surfactant replacement therapy would be effective in acute respiratory distress syndrome (ARDS), a recent large trial proved unsuccessful, possibly reflecting the nature of the surfactant used. Given the importance of the unique proteins in the action of surfactant, these would seem vital components of any exogenous surfactant. The ability to identify patients at risk of ARDS and to characterise their surfactant might allow prophylactic treatment with a nebulised, complementary, tailor-made preparation of surfactant. Advanced cases might undergo bronchoscopic focal lavage to remove plasma proteins and inflammatory mediators prior to focal instillation of surfactant to areas of greatest need. Ventilation regimens might be adjusted both to minimise trauma and to conserve endogenous surfactant.
尽管有人预计表面活性剂替代疗法在急性呼吸窘迫综合征（ARDS）中会有效，但最近的一项大型试验证明并不成功，这可能反映了所用表面活性剂的性质。鉴于独特蛋白质在表面活性剂作用中的重要性，这些似乎是任何外源性表面活性剂的关键成分。识别ARDS风险患者并表征其表面活性剂的能力，可能允许使用雾化的、互补的、量身定制的表面活性剂制剂进行预防性治疗。对于晚期病例，可能在将表面活性剂局部滴注到最需要的区域之前，先进行支气管镜局部灌洗以清除血浆蛋白和炎症介质。通气方案可能需要调整，以尽量减少创伤并保存内源性表面活性剂。
