肺表面活性物质及临床应用

Pulmonary Surfactant and Its clinical Applications

肺表面活性物质(pulmonary surfac-tant,PS)是一种具有表面活性的磷脂蛋白复合物,对稳定肺泡,减少呼吸功有重要生理功能。PS 由肺Ⅱ型细胞合成、储存并分泌到肺泡表面。PS 缺乏可引起早产儿呼吸窘迫综合征(respiratory disease syndrome,RDS)。急性呼吸窘迫综合征(acute respiratory disease syn-drome'ARDS)、重症肺炎及胎粪吸入综合征(meconnium aspiration syndrome'MAS)的发病过程可能与 PS 功能不良或不足有关。大规模的临床试验治疗已证实,外源性 PS 活性物质可有效预防和治疗新生儿 RDS。PS 治疗的适应证正在逐步增加。外源性 PS 治疗 ARDS、肺炎及 MAS 已取得了可喜成果。临床使用的 PS 分为2类:(1)天然 PS 制剂,由动物肺灌洗液或肺组织制备。(2)合成 PS 制剂。天然 PS 制剂疗效优于合成 PS 制剂。目前,人们正在研制含有 PS 蛋白或多肽的新的合成 PS 制剂。高效的合成 PS 制剂终将取代现有的 PS 制剂,更广泛地用于临床治疗。

The pulmonary surfactant (PS),a complex mixture of surface-active phospho lipids and proteins, plays an important physiological role in stabilizing the alveolar network of the lungs and reducing the work of breathing.PS is synthesized,stored,and secreted into the alveolar space by Type Ⅱ pneumoeytes.PS Deficiency leads to the respiratory distress syndrome (RDS)of pre- mature infants.PS Dysfunction is also an important con- tributor to acute respiratory distress syndrome (ARDS), severe pneumonia,and meconium aspiration syndrome (MAS).The efficacy of exogenous surfactant for pre- vention and treatment of meonatal RDS has been con- firmed in several large-scale clinical trials.Indications for surfactant therapy are gradually widening.Promising results of exogenous PS treatment have also been obtained in babies with MAS or pneumonia,and in children with ARDS.Clinical PS preparations are divided into two groups:(1)natural PS preparations derived from lung lavage fluid or from the lung tissueof animals;(2)syn- thetic PS preparations.The natural PS preparations are more effective than the synthetic ones.Newer synthetic surfactants containing surfactant proteinsor peptides are being developed.More effective synthetic surfactants would eventually replace the present generation of sur- factant preparations and be used more widely in the clin- ical treatment of patients.