猪肺磷脂液对足月呼吸窘迫综合征患儿气体交换以及肺动力的影响

Effect of poractant affa on kinetics and gas exchange in respiratory distress syndrome

目的研究不同猪肺磷脂液剂量对治疗足月呼吸窘迫综合征（RDS）患儿外源性肺表面活性物质双饱和磷脂酰胆碱（DSPC）的影响。方法选取足月RDS患儿122例，按照简单随机方法分为两组，A组80例，B组42例，分别使用100、200mg／kg猪肺磷脂液与U-13C标记的DSPC联合治疗。记录临床表现和呼吸参数，并计算DSPC的半衰期。结果A组有56例（70．0％）患儿于（25±11）h后第二次给药，18例（22．5％）患儿于（41±11）h后第三次给药。B组有12例（28．6％）患儿于（334-8）h后第二次给药，2例（4．8％）息儿第三次给药。B组DSPC半衰期长于A组[初次给药：（32±19）h比（15±15）h；第二次给药：（43±32）h比（21±13）h]，差异有统计学意义（P〈0．01或〈0．05）。两组DSPC合成率和分布在初次给药和第二次给药时是相同的。但是B组在初次给药和第二次给药后氧合指数远小于A组，差异有统计学意义（P〈0．01或〈0．05）。结论在猪肺磷脂液剂量为200mg／kg治疗足月RDS患儿时，会延长DSPC的半衰期、减少重复治疗以及提高氧合功能。

Objective To study exogenous surfactants disaturated phosphatidyl choline （DSPC） kinetics in full term infants with respiratory distress syndrome （RDS） who were treated with different dose of poractant alfa. Methods One hundred and twenty-two full term infants with RDS undergoing mechanical ventilation were divided into group A （80 cases） and group B （42 cases） by simple random method, who received 100 mg/kg or 200 mg/kg poractant alfa mixed with DSPC. Clinical manifestation and respiratory parameters were recorded, and DSPC half-life period and pool size and endogenous DSPC synthesis rate were calculated. Results Fifty-six infants （70.0%） received a second dose after （25 ± 11 ） h and 18 infants （22.5%） received a third dose after（41 ~ 11 ） h in group A. Twelve infants（28.6% ） received a second dose after （33 ± 8） h and 2 infants （4.8%） received a third dose in group B. DSPC half-life period in group B was longer than that in group A [ the first ： （ 32 ± 19） h vs. （ 15 ± 15 ） h ; the second ： （43 ± 32 ） h vs. （21 ± 13 ） h ], there was significant difference （P 〈 0.01 or 〈 0.05）. DSPC synthesis rate and pool size before the first and second doses had no difference between the two groups. But the oxygenation index at the first and the second dose in group B was less than that in group A,there were significant differences （P 〈0.01 or 〈0.05）. Conclusion Poractant alfa given to full term infants with RDS at a dose of 200 mg/kg results in a longer DSPC half-life period, fewer retreatments, and better oxygenation index values.