Surfactant therapy for acute lung injury and acute respiratory distress syndrome.
Surfactant therapy for acute lung injury and acute respiratory distress syndrome.
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DOI：
10.1016/j.ccc.2011.04.005
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发表时间：
2011-07
影响因子：
4.3
通讯作者：
Notter RH
中科院分区：
文献类型：
--
作者：
Raghavendran K;Willson D;Notter RH
本文探讨了外源性肺表面活性物质替代治疗及其在减轻临床急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）中的作用。生物物理研究证明，肺表面活性物质功能障碍可以通过增加表面活性物质浓度来逆转或减轻，并且对患有ALI/ARDS的动物进行的多项研究表明，外源性表面活性物质给药可以改善体内呼吸功能和肺力学。外源性表面活性物质治疗是新生儿重症监护中的常规干预措施，在预防或治疗早产儿呼吸窘迫综合征（NRDS）方面具有挽救生命的作用。在与肺损伤相关的呼吸衰竭和ALI/ARDS相关的应用中，表面活性物质治疗已被证明对患有肺炎和胎粪吸入性肺损伤的足月婴儿以及患有直接肺部形式的ALI/ARDS的21岁以下儿童有益。然而，将外源性表面活性物质治疗扩展到患有呼吸衰竭和临床ALI/ARDS的成人仍然是一个挑战。本文综述了表面活性物质治疗小儿和成人ALI/ARDS患者的临床研究，特别关注其在这些综合征的直接肺部形式患者中的潜在优势。还讨论了利用外源性表面活性剂与靶向炎症性肺损伤多方面病理生理学其他方面的药物联合进行机制治疗的基本原理。还描述了影响外源性表面活性剂治疗ALI/ARDS疗效的其他因素，包括难以有效地将表面活性剂递送至受损肺部以及临床表面活性剂药物之间存在活性差异。
This article examines exogenous lung surfactant replacement therapy and its utility in mitigating clinical acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). Biophysical research has documented that lung surfactant dysfunction can be reversed or mitigated by increasing surfactant concentration, and multiple studies in animals with ALI/ARDS have shown that respiratory function and pulmonary mechanics in vivo can be improved by exogenous surfactant administration. Exogenous surfactant therapy is a routine intervention in neonatal intensive care, and is life-saving in preventing or treating the neonatal respiratory distress syndrome (NRDS) in premature infants. In applications relevant for lung injury-related respiratory failure and ALI/ARDS, surfactant therapy has been shown to be beneficial in term infants with pneumonia and meconium aspiration lung injury, and in children up to age 21 with direct pulmonary forms of ALI/ARDS. However, extension of exogenous surfactant therapy to adults with respiratory failure and clinical ALI/ARDS remains a challenge. Coverage here reviews clinical studies of surfactant therapy in pediatric and adult patients with ALI/ARDS, particularly focusing on its potential advantages in patients with direct pulmonary forms of these syndromes. Also discussed is the rationale for mechanism-based therapies utilizing exogenous surfactant in combination with agents targeting other aspects of the multifaceted pathophysiology of inflammatory lung injury. Additional factors affecting the efficacy of exogenous surfactant therapy in ALI/ARDS are also described, including the difficulty of effectively delivering surfactants to injured lungs and the existence of activity differences between clinical surfactant drugs.
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影响因子：
2.1
作者：
BERGGREN, P;LACHMANN, B;ROBERTSON, B
通讯作者：
ROBERTSON, B
影响因子：
3
作者：
BIFFL, WL;MOORE, FA;BURCH, JM
通讯作者：
BURCH, JM
影响因子：
9.6
作者：
Bernard, GR;Wheeler, AP;Steinberg, KP
通讯作者：
Steinberg, KP
影响因子：
8.8
作者：
Bindl, L;Dresbach, K;Lentze, MJ
通讯作者：
Lentze, MJ
影响因子：
158.5
作者：
BERNARD, GR;LUCE, JM;BRIGHAM, KL
通讯作者：
BRIGHAM, KL