Surfactant Replacement Therapy for Respiratory Distress Syndrome
Surfactant Replacement Therapy for Respiratory Distress Syndrome
复制标题
呼吸窘迫综合征的表面活性剂替代疗法
作者：
Newborn
目前已明确，呼吸窘迫综合征（RDS）与早产相关的表面活性物质缺乏有关。自发现以来，已经有大量的研究确定了表面活性剂的生化组成及其与肺功能的关系。还在动物身上进行了大量的研究，以制定早产儿表面活性物质替代疗法的科学基础，以预防或减轻RDS的严重程度。
临床试验从Fujiwara等人2的补救治疗开始，随后进行了几项使用牛、人或合成表面活性剂的单一机构或多中心试验。这些临床试验中有许多已经发表，3-11和其他已提交出版。许多这些试验是随机的，表面活性物质治疗的形式是预防（出生时气管内滴注表面活性物质）或抢救（RDS诊断后的治疗）。根据已发表的数据，似乎在预防和补救试验中，呼吸状态均出现早期改善，如出生后前3天吸入氧浓度和平均气道压力要求降低所证明。一些（但不是全部）已发表的系列研究表明，在出生后的前28天内，死亡率和肺漏气发生率降低3，7，但没有一个已发表的系列研究显示，支气管肺发育不良、坏死性小肠结肠炎（NEC）、感染、动脉导管未闭（PDA）和脑室内出血（IVH）等疾病的发生率有所改善。事实上，一个系列显示表面活性剂治疗组NEC的发生率增加，6欧洲试验显示IVH的发生率增加，12一个系列显示表面活性剂治疗组PDA 9的发生率增加。
It is now clearly established that respiratory distress syndrome (RDS) is associated with prematurity-related surfactant deficiency. Since its discovery,1 there has been a considerable amount of research defining the biochemical composition of surfactant and its relationship to pulmonary function. A considerable amount of research has also been performed on animals to formulate the scientific basis for surfactant replacement therapy in premature infants to prevent or reduce the severity of RDS.
Clinical trials began with the rescue therapy by Fujiwara et al2 and were followed by several single institution or multicenter trials using bovine, human, or synthetic surfactants. Many of these clinical trials have been published,3-11 and others have been submitted for publication. Many of these trials were randomized, and the form of surfactant therapy was either prevention (endotracheal instillation of surfactant at birth) or rescue (treatment after RDS is diagnosed). Based on the published data, it appears that in both prevention and rescue trials, there is early improvement in respiratory status as evidenced by decreased inspired oxygen concentration and mean airway pressure requirements during the first 3 days of life. Some, but not all, published series suggest a reduction in mortality rates and incidence of pulmonary air leaks3,7 during the first 28 days of life, but none of the published series appear to show an improvement in the incidence of such morbidities as bronchopulmonary dysplasia, necrotizing enterocolitis (NEC), infections, patent ductus arteriosus (PDA), and intraventricular hemorrhage (IVH). In fact, one series showed increased incidence of NEC in the surfactant-treated group,6 the European trial showed an increased incidence of IVH,12 and one series showed an increased incidence in PDA9 in the surfactant-treated group.
用人类表面活性剂预防性治疗极早产儿。
DOI：
10.1056/nejm198609253151301
发表时间：
1986
期刊：
The New England journal of medicine
影响因子：
--
作者：
Merritt,TA;Hallman,M;Bloom,BT;Berry,C;Benirschke,K;Sahn,D;Key,T;Edwards,D;Jarvenpaa,AL;Pohjavuori,M
通讯作者：
Pohjavuori,M