IJsselstijn H, Zimmermann L J, Bunt J E, de Jongste J C, Tibboel D
Department of Pediatric Surgery, Erasmus University and University Hospital/Sophia Children's Hospital, Rotterdam, The Netherlands.
Crit Care Med. 1998 Mar;26(3):573-80. doi: 10.1097/00003246-199803000-00035.
Infants with congenital diaphragmatic hernia may have biochemically immature lungs. However, normal lecithin/sphingomyelin ratios and phosphatidylglycerol concentrations have been reported in the amniotic fluid of congenital diaphragmatic hernia patients. We hypothesized that if the lungs of congenital diaphragmatic hernia patients are surfactant deficient, that this condition would be reflected in an altered surfactant composition in the bronchoalveolar lavage fluid compared with that composition in age-matched controls.
Prospective, controlled study.
Surgical intensive care unit in a Level III pediatric university hospital.
Four groups were studied: two groups of congenital diaphragmatic hernia patients (conventionally ventilated, n = 13; treated with extracorporeal membrane oxygenation, n = 5); and two control groups (conventionally ventilated, n = 13; extracorporeal membrane oxygenation, n = 6).
Bronchoalveolar lavage, using a blind, standardized technique, was performed in conventionally ventilated congenital diaphragmatic hernia patients, extracorporeal membrane oxygenation-treated congenital diaphragmatic hernia patients, age-matched conventionally ventilated controls without pulmonary abnormalities, and extracorporeal membrane oxygenation-treated infants without congenital diaphragmatic hernia.
The concentrations of different surfactant phospholipids and the fatty acid composition of phosphatidylcholine in bronchoalveolar lavage fluid were measured. No significant differences between the concentrations of phosphatidylcholine and phosphatidylglycerol, and the lecithin/sphingomyelin ratios, were found between the four groups. The fatty acid composition of phosphatidylcholine in conventionally ventilated patients showed a median percentage of palmitic acid within the normal range for age in both groups: 68% in congenital diaphragmatic hernia patients and 73% in controls (p < .001).
Our findings indicate that the concentrations of different phospholipids are similar in congenital diaphragmatic hernia patients and controls without congenital diaphragmatic hernia. A primary surfactant deficiency is unlikely in infants with congenital diaphragmatic hernia. However, secondary surfactant deficiency after respiratory failure may be involved.
先天性膈疝患儿的肺在生化方面可能发育不成熟。然而，有报道称先天性膈疝患者的羊水卵磷脂/鞘磷脂比值及磷脂酰甘油浓度正常。我们推测，如果先天性膈疝患者的肺表面活性物质不足，那么与年龄匹配的对照组相比，支气管肺泡灌洗（BAL）液中表面活性物质的组成将会发生改变，从而反映出这种情况。
前瞻性对照研究。
一所三级儿科大学医院的外科重症监护病房。
共研究了四组：两组先天性膈疝患者（接受传统机械通气，n = 13；接受体外膜肺氧合治疗，n = 5）；以及两组对照组（接受传统机械通气，n = 13；接受体外膜肺氧合治疗，n = 6）。
采用盲法标准化技术，对接受传统机械通气的先天性膈疝患者、接受体外膜肺氧合治疗的先天性膈疝患者、年龄匹配且无肺部异常的接受传统机械通气的对照组患者，以及接受体外膜肺氧合治疗且无先天性膈疝的婴儿进行支气管肺泡灌洗。
测量支气管肺泡灌洗液中不同表面活性物质磷脂的浓度以及磷脂酰胆碱的脂肪酸组成。四组之间在磷脂酰胆碱和磷脂酰甘油的浓度以及卵磷脂/鞘磷脂比值方面未发现显著差异。接受传统机械通气患者的磷脂酰胆碱脂肪酸组成显示，两组棕榈酸的中位百分比均在该年龄的正常范围内：先天性膈疝患者为68%，对照组为73%（p <.001）。
我们的研究结果表明，先天性膈疝患者与无先天性膈疝的对照组中不同磷脂的浓度相似。先天性膈疝婴儿不太可能存在原发性表面活性物质缺乏。然而，呼吸衰竭后可能会出现继发性表面活性物质缺乏。
