Surfactant Replacement Therapy from 1986 to 2006: A 20-Year Success Story
Surfactant Replacement Therapy from 1986 to 2006: A 20-Year Success Story
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1986 年至 2006 年表面活性剂替代疗法：20 年成功故事
作者：
O. Saugstad;T. Curstedt;H. Halliday;B. Robertson;C. Speer
呃，超过 5,000 名婴儿被随机分配到不同的猪肺阿尔法研究中。已发表超过 1,500 篇文章，每年一度的国际研讨会也越来越受欢迎。阿姆斯特丹会议涉及临床和基础科学研究人员，这确实是幸运的。国际表面活性剂替代研讨会仍然吸引了同样一批热情的临床和基础科学研究人员。自 1986 年以来，该小组不断发展壮大，现已成为全球性的组织，形成了一个强大而高效的研究网络来进行持续的试验。该组织还通过帕尔马的 Chiesi Farmaceutici 基金会支持西藏的工作。在过去的两年里，该基金会为Nepu村的植树活动和建造一所新学校做出了贡献。还将建造一个配备几张床位的医疗诊所，供重症患者使用，不仅为内普村提供服务，也为周边村庄提供服务。 2006 年，在第一次研讨会召开 20 年后，我们在奥斯陆举行了第二次会议。 1987 年春天，当第一个婴儿在国家医院接受 Curosurf 治疗时，表面活性剂疗法被引入挪威。这种疗法的引入最初遇到了很大的阻力，但今天它被认为是非常有益的，以至于被所有人接受，年轻一代的医生和护士不记得半数 RDS 婴儿死亡的日子。 1986 年 4 月 26 日，二十六位科学家齐聚阿姆斯特丹，讨论新生儿护理方面的一项新成就。 Bengt Robertson 和 Tore Curstedt 开发了一种猪表面活性剂，用于临床治疗早产儿呼吸窘迫综合征 (RDS)。第一个随机对照试验已经运行了 12 个多月，小组开会讨论其进展并计划进一步的研究。该产品当时尚未注册，其早期开发背后不存在任何商业利益。在阿姆斯特丹举行的小型聚会后来成为第一届国际表面活性剂替代研讨会，其目的是为了改善早产儿的健康和生存，这些早产儿在患上严重的 RDS 后死亡率很高。回想起来，阿姆斯特丹会议是实现这些目标的最重要的会议之一。 20 年后的今天，近 600,000 名新生儿接受了这种通用名为 Poracant alfa 的表面活性剂的治疗。在最初的研究中，出生体重在 700 至 2,000 克、严重 RDS 和需氧量 6 60% 的对照组婴儿的死亡率约为 50%。气管内注射一剂猪肺α可将死亡率降低至约30%。后来的试验表明，通过多次剂量和更多经验，死亡率进一步降低至 10% 左右，这对这些患病早产儿的护理构成了一场革命。这种表面活性剂和类似的表面活性剂挽救了数以万计的生命。 20 年后的今天在线发布：2006 年 6 月 1 日
er, more than 5,000 infants have been randomized into various studies of poractant alfa. More than 1,500 articles have been published and the annual international workshops have become more and more popular. The Amsterdam meeting involved clinical as well as basic science researchers which was fortunate indeed. The International Workshops on Surfactant Replacement still attract the same group of enthusiastic clinical and basic science researchers. Since 1986, the group has grown and it has now become global forming a powerful and effi cient research network to conduct ongoing trials. The group has also been able to support work in Tibet through the Chiesi Farmaceutici foundation in Parma. In the last 2 years, the foundation has contributed to tree planting and the building of a new school in the Nepu village. A medical dispensary with a few beds for more severely ill patients also will be built and will serve not only the Nepu village but also the surrounding villages. In 2006, 20 years after the fi rst workshop, we are meeting in Oslo for the second time. Surfactant therapy was introduced into Norway when the fi rst infant was treated with Curosurf in the National Hospital in spring 1987. The introduction of this therapy was initially met with substantial resistance but today it is considered so evidently benefi cial that it is accepted by all and a younger generation of doctors and nurses cannot remember the days when half of the babies with RDS died. On 26th April 1986, twenty-six scientists met in Amsterdam to discuss a new achievement in the care of newborn infants. Bengt Robertson and Tore Curstedt had developed a porcine surfactant for clinical use to treat respiratory distress syndrome (RDS) in the preterm neonate. The fi rst randomized controlled trial had been running for over 12 months and the group met to discuss its progress and plan further studies. The product was not registered at this time and no commercial interests stood behind its early development. The small gathering in Amsterdam that later turned out to be the 1st International Workshop on Surfactant Replacement was driven by a genuine interest to improve health and survival of preterm infants who suffered high mortality rates after developing severe RDS. In retrospect, the meeting in Amsterdam was one of the most important in achieving these goals. Today, 20 years later, almost 600,000 newborn infants have been treated with this surfactant with the generic name poractant alfa. In the original study, mortality in the control group of infants who had birth weights between 700 and 2,000 g, severe RDS and oxygen requirements 6 60% was about 50%. One intratracheal dose of poractant alfa reduced mortality to about 30%. Later trials showed that with multiple doses and more experience the mortality was reduced further to about 10% which constituted a revolution in the care of these ill preterm babies. Tens of thousands of lives have been saved by this and similar surfactants. Today 20 years latPublished online: June 1, 2006