Bronchoscopic administration of bovine natural surfactant in ARDS and septic shock:: impact on biophysical and biochemical surfactant properties
Bronchoscopic administration of bovine natural surfactant in ARDS and septic shock:: impact on biophysical and biochemical surfactant properties
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DOI：
10.1183/09031936.02.00243302
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发表时间：
2002-05-01
影响因子：
24.3
通讯作者：
Seeger, W
中科院分区：
文献类型：
--
作者：
Günther, A;Schmidt, R;Seeger, W
本研究的目的是探讨支气管镜下应用表面活性物质对严重和早期急性呼吸窘迫综合征(ARDS)和感染性休克患者生化和生物物理特性的影响。共有27名ARDS患者通过柔性支气管镜接受了300-500 mg·kg.body.(-1)的天然牛表面活性物质提取物(Alveoact(R))。分别于给药前3h、给药后15h~18h和72h行肺泡灌洗。与接受相同冲洗程序的健康志愿者进行比较(对照组，n=12)。ARDS患者自始至终都遇到了严重的生物物理和生化表面活性物质异常。这些包括大量的肺泡蛋白负荷，大的表面活性物质聚集体(LA)的百分比减少，棕榈酰化磷脂酰胆碱物种的丢失以及LA组分中表面活性物质载脂蛋白(SP)-A、SP-B和SP-C的显著减少。最小(伽马胺)和吸附(伽马德)表面张力值(脉动气泡表面测定仪)都显著增加。表面活性物质治疗使可洗脱性磷脂(PL)池显著增加，但肺泡表面活性物质抑制蛋白负荷仍占优势。注意到磷脂酰胆碱类的磷脂酰胆碱的脂肪酸组成、磷脂酰胆碱组分及其SP-B和SP-C(但不包括SP-A)的含量以及磷脂酰胆碱的脂肪酸组成的深远或完全标准化。在严重急性呼吸窘迫综合征患者支气管镜下大量应用天然牛表面活性物质可使生化表面活性物质的性质得到深远的恢复，并显著改善生物物理表面活性物质的功能，但尚未完全正常化。
The purpose of the present study was to investigate the impact of bronchoscopic surfactant administration, on the biochemical and biophysical surfactant properties, in patients with severe and early acute respiratory distress syndrome (ARDS) and septic shock.A total number of 27 ARDS patients received 300-500 mg.kg.body.weight(-1) of a natural bovine surfactant extract (Alveofact(R)) via a flexible bronchoscope. Bronchoalveolar lavages were performed 3 h prior to, and 15-18 h and 72 h after surfactant administration. A comparison to healthy volunteers, undergoing an identical lavage procedure, was made (control, n=12).Severe biophysical and biochemical surfactant abnormalities were encountered throughout in the ARDS patients. These included a massive alveolar protein load, a reduced percentage of large surfactant aggregates (LA), a loss of palmitoylated phosphatidylcholine species and a significant reduction of surfactant apoprotein (SP)-A, SP-B and SP-C in the LA fraction. Both minimum (gammamin) and adsorption (gammaads) surface tension values (pulsating bubble surfactometer) were dramatically increased. Surfactant treatment resulted in a marked increase in the lavagable phospholipid (PL) pool, but predominance of the alveolar surfactant-inhibitory protein load was still encountered. Far-reaching or even complete normalization of the PL profile, the LA fraction and its SP-B and SP-C (but not SP-A) content as well as the fatty acid composition of the phosphatidylcholine class was noted. Surface tension lowering properties (gammamin and gammaads) significantly improved, but were still not fully normalized.Bronchoscopic administration of large quantities of natural bovine surfactant in severe acute respiratory distress syndrome causes far-reaching restoration of biochemical surfactant properties and significant improvement, however not full normalization, of biophysical surfactant function.