肺表面活性物质治疗新生儿胎粪吸入综合征的临床研究

Surfactant therapy in neonates with meconium aspiration syndrome

目的探讨肺表面活性物质（ＰＳ）治疗新生儿胎粪吸入综合征（ＭＡＳ）的有效性及临床价值。方法采用气管内滴入ＰＳ治疗８例ＭＡＳ患儿，其中６例接受ＰＳ２剂，２例接受ＰＳ３剂。结果给予首剂ＰＳ后１０分钟患儿青紫迅速消失，皮肤转红润，经皮测定血氧饱和度（ＴｃＳａＯ２）升高。３０分钟后患儿低氧血症迅速改善，动脉血氧分压、动脉血氧分压与吸入氧浓度比值、动脉肺泡血氧分压比值、呼吸机有效指数较治疗前显著增高，分别由原来的５２８±０９８ｋＰａ、８６６±３５２ｋＰａ、０１２±００６ｋＰａ及０１４±００６ｍｌ·ｋＰａ－１·ｋｇ－１增加到８９１±１４３ｋＰａ、１６８１±４１８ｋＰａ、０２１±００５ｋＰａ及０２６±００７ｍｌ·ｋＰａ－１·ｋｇ－１；而吸入氧浓度及平均气道压逐渐降低，由原来的０６８±０１９ｋＰａ及２２０±０４２ｋＰａ降低到０５３±００８ｋＰａ及１９３±０４８ｋＰａ。重复应用ＰＳ后亦有相似效果。结论ＰＳ能有效地改善ＭＡＳ患儿肺顺应性及氧合功能。重复应用ＰＳ可巩固和加强疗效。

Objective To study the efficacy of pulmonary surfactant (Survanta) in newborn infants with meconium aspiration syndrome (MAS). Methods Eight neonates with MAS were treated with pulmonary surfactant. Six of then received a second dose of surfactant and two received a third dose. Results Hypoxemia in those patients was markedly relieved after administration of the first dose of surfactant, and values for arterial partial pressure oxygen (PaO 2), PaO 2/fraction of inspired oxygen (FiO 2) ratio, arterial oxygen/ alveolar oxygen ratio (a/A PO 2) and ventilator efficiency index(VEI) significantly increased from 5.28±0.98 kPa, 8.66±3.52 kPa, 0.12±0.06 kPa and 0.14±0.06 ml·kPa -1 ·kg -1 to 8.91±1.43 kPa, 16.81±4.18 kPa, 0.21±0.05 kPa and 0.26± 0.07 ml·kPa -1 ·kg -1 within 30 minutes after therapy, but FiO 2 and mean airway pressure (MAP) significantly decreased from 0.68±0.19 and 2.20±0.42 kPa to 0.53±0.08 and 1.93±0.48 kPa. Similar efficacy was seen after repeated administration of surfactant. Conclusion The results indicate that surfactant therapy may result in a rapid improvement in dynamic compliance and oxygenation in newborns with MAS. Similar efficacy was obtained after the second dose and third dose administration.