Valls-i-Soler A, López-Heredia J, Fernández-Ruanova M B, Gastiasoro E
Department of Pediatrics, Hospital de Cruces, and Basque University School of Medicine, Basque Country, Spain.
Acta Paediatr. 1997 Jul;86(7):747-51. doi: 10.1111/j.1651-2227.1997.tb08579.x.
The aim of this study was to compare the incidence of acute adverse events and long-term outcome of two different surfactant dosing procedures in respiratory distress syndrome (RDS). The effects of two surfactant dosing procedures on the incidence of transient hypoxia and bradycardia, gas exchange, ventilatory requirements and 28 d outcome were compared. The patients, comprising 102 infants (birthweight 600-2000 g) with RDS on mechanical ventilation with FiO2 > or = 0.4, were randomized at 2-24 h to receive 200 mg kg(-1) of Curosurf; in 56 it was given by bolus delivery, and in 55 by a simplified technique (dose given in 1 min via a catheter introduced through a side-hole in the tracheal tube adaptor. The baby's position was not changed and ventilation was not interrupted). Two additional surfactant doses (100 mg kg(-1)) were also given, by the same method, if ventilation with FiO2 > or = 0.3 was needed 12 and 24 h after the initial dose. The number of episodes of hypoxia and/or bradycardia was similar in both groups. A slight and transient increase in PaCO2 was observed in the side-hole group. The efficacy of the surfactant, based on oxygenation improvement, ventilator requirements, number of doses required and incidence of air leaks, was similar. No differences were observed in the incidence of intraventricular haemorrhage, patent ductus arteriosus, bronchopulmonary dysplasia or survival. In conclusion, a simplified surfactant dosing procedure not requiring fractional doses, ventilator disconnection, changes in the baby's position or manual bagging was found to be as effective as bolus delivery. The number of dosing-related transient episodes of hypoxia and bradycardia was not decreased by the slow, 1 min, side-hole instillation procedure.
本研究旨在比较两种不同表面活性剂给药方案在呼吸窘迫综合征（RDS）中的急性不良事件发生率和长期预后。比较了两种表面活性剂给药方案对短暂性低氧血症和心动过缓发生率、气体交换、通气需求及28天预后的影响。102例机械通气的RDS婴儿（出生体重600 - 2000g，吸入氧分数≥0.4）在2 - 24小时被随机分组，56例接受200mg/kg珂立苏，通过推注给药；55例接受简化技术给药（通过气管导管适配器侧孔插入的导管在1分钟内给予剂量，婴儿体位不变且通气不中断）。如果初始剂量后12小时和24小时需要吸入氧分数≥0.3的通气，则同样方法额外给予两剂表面活性剂（100mg/kg）。两组低氧血症和/或心动过缓发作次数相似。侧孔组观察到PaCO₂有轻微短暂升高。基于氧合改善、通气需求、所需剂量数和空气泄漏发生率，表面活性剂的疗效相似。在脑室内出血、动脉导管未闭、支气管肺发育不良或生存率方面未观察到差异。总之，发现一种不需要分次给药、断开呼吸机、改变婴儿体位或人工辅助通气的简化表面活性剂给药方案与推注给药同样有效。缓慢的1分钟侧孔滴注给药方案并未减少与给药相关的短暂性低氧血症和心动过缓发作次数。
