重症新生儿肺透明膜病肺表面活性物质替代治疗

探讨外源性肺表面活性物质治疗重症新生儿肺透明膜病（HMD）的疗效。方法对重症HMD病儿于生后气管内给药,观察用药后临床表现、血气结果、肺部X线以及并发症的变化。结果33例中30例给药后即刻症状和体征改善,血气分析结果明显好转;给药3d内肺部X线23例有明显改善;33例中16例存活,其中9例有严重并发症。结论外源性肺表面活性物质对重症HMD有肯定疗效,在改善氧气交换和肺部病变方面发挥重要作用。     

肺表面活性物质治疗严重新生儿肺透明膜病

7例严重早产儿肺透明膜病（HMD）用肺表面活性物质（curosurf）替代疗法，给予Curosurf的标准包括机械通气所需之FiO2≥0．6及动脉氧分压／肺泡氧分压（a／APO2）≤0．1，7例在年龄5～48小时给单剂Curosurf（200mg／kg）治疗，给药30分钟后7例的氧合均迅速改善，a／APO2及PaO2／FiO2各增加了2．5～4．7倍及2．5～4．4倍，无气漏并发，6例存活，1例死于医院内感染，Curosurf治疗有效的改善严重HMD的转归及减低气漏的发生率     

表面活性物质对新生儿肺透明膜病血流动力学的影响

自 70年代初美国 chu等人首次应用人工合成肺表面活性物质 (PS)治疗新生儿肺透明膜病 (HMD) ,结果 79%的新生儿肺顺应性得到了提高。如果给予外源性 PS治疗HMD,则可使严重的 HMD患儿的病情得以明显的改善(1 ) 。与 30年前不同的是 ,近年来一些研究发现 ,快速气道内滴注 PS,可增加肺有效循环血量 ,改善肺部的气体交换增加肺总循环血流量 ,从而迅速改善呼吸功能 ,但也可造成肺血管阻力低于体循环阻力 ,使左向右分流量增加 ,造成左心输出量不足、体循环灌注下降、脑血流量降低致脑损害的危险 (2 )。本文就近年来 PS对 HMD血流动力学方…     

超未成熟儿肺透明膜病的肺表面活性物质替代治疗

本文应用气管内滴注ＰＳ对９例合并ＨＭＤ的ＥＩＩ进行治疗。治疗后，患儿紫绀迅速消失，皮肤转红润，经皮测血氧饱和度明显增高。血氧分压、血氧分压与吸入氧浓度比值及动脉与肺泡氧分压比值较用药前显著升高，差异存在显著性意义。Ｘ线片可见肺充气逐渐好转，肺透亮度增加。提示ＰＳ能够明显缓解临床症状，改善肺氧合功能。对ＥＩＩ的ＨＭＤ应早期、足量，反复用药，并加强用药后的呼吸管理，以减少并发症发生。     

肺表面活性物质治愈早产儿肺透明膜病12例

目的　探讨用外源性肺表面活性物质 (PS)治疗肺透明膜病 (HMD)的方法及效果。方法　采用气管插管、从气管内滴入PS ,用药前吸净呼吸道分泌物。结果　用药后 ,HMD患儿症状、体征渐减轻直至消失 ,动脉血氧分压 (PaO2 )、经皮血氧饱和度 (TcSaO2 )升高 ,动脉血二氧化碳分压降低 ,12h后 ,PaO2 ,PaCO2 ,TcSaO2 已达正常。 2 4h后 ,胸片示肺充气好转 ,透亮度增加。结论　PS能改善HMD患儿肺顺应性及氧合功能 ,使用时应注意方法。     

肺表面活性物质治疗早产儿肺透明膜病临床观察

肺透明膜病（HMD）,又称新生儿呼吸窘迫综合征（NRDS）,是早产儿常见的危重疾病,病死率高.其直接原因是缺乏肺表面活性物质（PS）.目前国内大中城市已普遍用PS替代治疗或预防NRDS，并取得较好疗效。随着人民生活水平的提高，在基层医院选择使用PS的病例逐年增加。本院新生儿重症监护室（NICU）在2003年12月至2006年12月，采用PS加持续气道正压呼吸（CPAP）治疗早产儿肺透明膜病取得了较满意的效果，现总结如下。     

肺表面活性物质治疗早产儿肺透明膜病14例

目的：探讨肺表面活性物质（ＰＳ）在治疗早产儿肺透明膜病（ＨＭＤ）的疗效和临床价值。方法：对１４例ＨＭＤ早产儿用肺表面活性物质治疗前与用药后６ ｈ,１２ ｈ的血气指标和机械通气参数进行对比,观察肺功能情况及并发症。结果：１４例患儿在应用ＰＳ后２ ｈ皮肤发绀改善,经皮测血氧饱和度逐渐升高。６ ｈ,１２ ｈ后血气分析指标动脉血氧分压（ＰａＯ２）由（４１±１２）上升至（７８±２３）、（８２±２６）ｍｍＨｇ;动脉压－肺泡氧分压比值（ａ／ＡＰＯ２）由（０．１２±０．０５）上升至（０．２５±０．１２）、（０．２７±０．１５）;ＰａＯ２／ＦｉＯ２由（６８±２２）上升至（１４９±６５）、（１６１±７６）;ｐＨ值由（７．２１±０．１２）上升至（７．３４±０．０７）、（７．３８±０．０８）;ＰａＣＯ２由（５７±１２）降至（４５±１１）、（３９±１４） ｍｍＨｇ;机械通气参数（ＦｉＯ２）由（０．６９±０．１６）降至（０．５２±０．１２）、（０．４８±０．１１）;与用药前比较差异均有显著性意义（Ｐ＜０．０１）。用药后２４ ｈ胸部Ｘ线照片肺部病变均有改善。治愈１０例,２例死亡,２例放弃治疗。结论：肺表面活性物质治疗ＨＭＤ能快速、有效地改善肺功能和     

肺表面活性物质治疗肺透明膜病Ⅱ级的疗效评价

目的 探讨肺表面活性物质(PS)在治疗新生儿肺透明膜病(HMD)Ⅱ级的疗效。方法 对60例经X线胸片检查为HMDⅡ级的患儿。30例6小时内应用肺表面活性物质;30例无应用肺表面活性物质,通过用药后20小时(或约生后24小时)X线胸片的诊断与上呼吸机时间、并发症的比较分析,评价肺表面活性物质治疗肺透明膜病的疗效。结果 两组病例在生后24小时的X线胸片,平均上呼吸机时间,住院天数、死亡率,有显著性差异,P<0.05。并发症方面,肺炎发生率显著性差异,P<0.05。结论 PS在治疗HMD中可以明显改善肺透明膜病的转归,减少并发症,降低死亡率。     

肺表面活性物质治疗肺透明膜病21例分析

目的　分析影响肺表面活性物质（ＰＳ） 疗效的因素。方法　回顾２１ 例ＰＳ治疗病例,分为治愈与死亡两组,分析影响ＰＳ疗效的因素。结果　影响ＰＳ疗效因素分别为酸中毒,低体重,使用剂量,高碳酸血症及肺出血,颅内出血。结论　在ＰＳ治疗中应纠正酸中毒及高碳酸血症,使用足量ＰＳ,并注意预防肺出血,颅内出血等并发症。     

Surfactant quantity and composition during recovery from hyaline membrane disease

The appearance of phosphatidylglycerol in the tracheal wash of infants with hyaline membrane disease (HMD) has been reported to be associated with clinical signs of recovery. We analyzed lung tissue and bronchoalveolar lavage surfactant in an animal model of HMD to determine whether phosphatidylglycerol or some other component is necessary for recovery. The amount and composition of phospholipid (PL) was determined in the premature Macaca nemestrina monkey (140 days' gestation) during an acute stage of HMD, and in two stages of recovery. These changes were compared to observations made in healthy premature controls (140 days), gestational age-matched fetuses (140 days), and fetuses of 150 days' gestation (term = 168 days). The amount of PL and its surfactant composition in lung homogenates of the right lower lobe and in lavage of the excised left lung was determined. Compared to 140-day fetuses, the healthy controls had a several-fold increase in lavage PL and disaturated phosphatidylcholine (DSPC) during the first few days of life (p less than 0.05). Prior to recovery, animals with HMD had no such increase in lavage PL or DSPC and demonstrated poor deflation stability. Recovery was associated with increased tissue and lavage PL (p less than 0.05) and increased fractions of phosphatidylinositol and DSPC (p less than 0.05), but not phosphatidylglycerol. The tissue compositional changes observed during recovery reflected maturational changes observed in the fetal animals studied at 10 days' greater gestational age.(ABSTRACT TRUNCATED AT 250 WORDS)     

影响机械通气治疗肺透明膜病患儿疗效的因素分析

目的 探讨机械通气治疗新生儿肺透明膜病（HMD）的预后及其影响因素。方法 回顾2002年1月至2006年1月我院新生儿重症监护室经机械通气治疗的116例肺透明膜病病例，分析其疗效，对治愈组和死亡组的胎龄、体重、胸片分级、入院时肛温、血pH、有无使用肺表面活性物质（PS）、呼吸机参数、并发症等对比分析。结果 机械通气治疗HMD的治愈率是86．2％，早期酸中毒、上机时高吸气峰压（PIP）及肺出血等严重并发症是死亡率增加的危险因素，而同时采用PS替代治疗可以明显提高治愈率。结论 机械通气是治疗HMD的重要手段，同时采用PS治疗可以取得更好疗效，早期酸中毒及上机时高PIP提示疗效较差，积极防治并发症可改善疗效。     

影响机械通气治疗肺透明膜病患儿疗效的因素分析

目的探讨机械通气治疗新生儿肺透明膜病(HMD)的预后及其影响因素。方法回顾2002年1月至2006年1月我院新生儿重症监护室经机械通气治疗的116例肺透明膜病病例,分析其疗效,对治愈组和死亡组的胎龄、体重、胸片分级、入院时肛温、血pH、有无使用肺表面活性物质(PS)、呼吸机参数、并发症等对比分析。结果机械通气治疗HMD的治愈率是86·2%,早期酸中毒、上机时高吸气峰压(PIP)及肺出血等严重并发症是死亡率增加的危险因素,而同时采用PS替代治疗可以明显提高治愈率。结论机械通气是治疗HMD的重要手段,同时采用PS治疗可以取得更好疗效,早期酸中毒及上机时高PIP提示疗效较差,积极防治并发症可改善疗效。     

Yellow hyaline membrane disease in neonates: clinical diagnosis by tracheal aspiration cytology

Yellow hyaline membrane disease (YMH) of the neonate may be diagnosed clinically by tracheal aspiration cytology, an easily accessible, noninvasive, and safe technique. Since the frequent association of yellow membranes and kernicterus in premature infants at relatively low levels of serum bilirubin is significant, this means of diagnosis during life may be useful in identifying infants at risk for kernicterus. We also suggest use of this technique in evaluating the role of possible factors in the pathophysiology of yellow hyaline membranes.     

Cardiovascular response to dopamine in hypotensive preterm neonates with severe hyaline membrane disease

The effect of low dose (2, 4, and 8 g/kg per min) dopamine infusion on blood pressure, heart rate and renal function was studied in 18 hypotensive, preterm infants with severe hyaline membrane disease (HMD). Significant dose-related effects found during dopamine infusion were systolic and diastolic blood pressure elevation and diuretic effect, while heart rate increase occurred only with 8 g/kg per min of the drug. This indicates, that in the preterm neonate, dopamine at low doses has a pronounced effect on the alpha-and dopamine-receptors, while its beta-receptor stimulating activity is minimal. We demonstrated a significantly decreased metabolic clearance rate of dopamine in preterm infants. Thus, beside the differences in the vascular receptors' maturation, the decreased metabolic clearance rate should also be taken into account when explaining the cardiovascular and renal effects of low dose dopamine infusion in these babies. Dopamine was found to be useful in normalizing low arterial blood pressure, in improving impaired peripheral circulation, and in producing a marked diuresis in hypotensive preterm neonates with severe hyaline membrane disease.Abbreviations CVP central venous pressure - HMD hyaline membrane disease - tcpO₂ transcutaneous oxygen tension - TPVR total peripheral vascular resistance     

Randomized controlled trial of exogenous surfactant for the treatment of hyaline membrane disease

We conducted a prospective, randomized, unblinded, controlled trial of exogenous bovine surfactant (surfactant TA) in premature infants requiring ventilator support for the treatment of severe hyaline membrane disease. Forty-one low birth weight infants with severe hyaline membrane disease were randomly assigned to saline or surfactant therapy and treated within eight hours of birth. Significant improvements in oxygenation (increased arterial/alveolar PO2) and respiratory support (decreased mean airway pressure) were seen in the group receiving surfactant within four hours after treatment. These improvements were maintained in the surfactant-treated infants, who also had fewer pneumothoraces and fewer number of days in environments of fractional inspiratory oxygen greater than 0.4 mm Hg. No problems were associated with administration of surfactant, and no acute side effects were detected. We conclude that exogenous surfactant, administered early in the course of severe hyaline membrane disease, is an effective therapy that can diminish the amount of respiratory support required during the first 48 hours of life.