猪肺表面活性物质治疗胎粪吸入综合征的多中心随机对照研究

目的在中国19家新生儿重症监护病房开展猪肺表面活性物质治疗足月儿或近足月儿重症胎粪吸入综合征(MAS)多中心随机对照临床试验,判断其疗效和安全性。方法61例重症MAS患儿在生后36h内入选试验,随机分为表面活性物质治疗组(PS,n=31)和对照组(C,n=30)。PS首剂给药量为200mg/(kg·w),重复给药时追加剂量为200、100、100mg/kg。主要疗效评估指标为PS治疗后24h氧合指数(OI)小于10,动脉/肺泡氧分压比值(a/APO2)较用药前基础值增加100%;次要评估指标为机械通气时间、并发症发生率和存活出院的患儿数。结果两组患儿一般临床特征相似。在随机化治疗后24h,与C组相比,PS组平均OI值降低(10.9vs.8.1)、有较多患儿a/APO2较基础值增加100%(48%vs.83%,P<0.01)、PaO2/FiO2曲线下面积更大[(3762±1877)vs.(2715±1644)mmHg·h(P<0.05,1mmHg=0.133kPa)]。在治疗的3、7天,上述参数PS组仍优于C组。两组间在机械通气时间、主要并发症发生率和存活率上差异无统计学意义。结论表面活性物质治疗重症MAS能改善氧合,不增加并发症的发生。     

Treatment of severe meconium aspiration syndrome with porcine surfactant

Abstract This study is based on clinical data from a retrospective series of 54 infants with meconium aspiration syndrome treated with porcine surfactant at a median age of 14 h (range 1–176 h). Median arterial/alveolar oxygen tension ratio (a/APO₂ ratio) before treatment was 0.08 (range 0.02–0.23) and oxygenation index 25 (range 6–110). After treatment with surfactant at an initial dose of 50–200 mg/kg there was a modest but statistically significant increase in a/APO₂ ratio associated with a reduction of oxygenation index. Ten (18%) babies showed a 3–4 fold increase in a/APO₂ ratio within 1–2 h of treatment. Twenty-four (44%) babies showed little or no response by 1–2 h with the remaining infants showing modest improvement in oxygenation. One third of babies required repeated doses of surfactant. Twenty-eight day survival was 81%, with two babies requiring extracorporeal membrane oxygenation. Conclusion Natural surfactant treatment of severe meconium aspiration may prove to be a useful intervention and randomised controlled clinical trials should be undertaken.     

猪肺表面活性物质气管内灌洗治疗重症新生儿胎粪吸入综合征的临床研究

目的 研究猪肺表面活性物质（PS）气管内灌洗治疗重症新生儿胎粪吸入综合征（MAS）的临床疗效。方法 2010 年1 月至 2013 年6 月收治的重症MAS 足月儿136 例, 随机分为PS 气管内灌洗治疗组（灌洗组）和PS 气管内注入治疗组（注入组）,每组68 例。灌洗组采用稀释后的PS 3~5 mL/次（12 mg/mL）气管内灌洗;注入组采用PS 原液200 mg/kg（首剂）气管内注入。比较两组患儿治疗前及治疗后2、12、24、48 h的血气分析、OI 值、P/F 值的动态变化,以及两组患儿的上机时间、并发症、治愈率。结果 灌洗组在PS 使用后的12 h、24 h、48 h PaO2、PaCO2、OI、P/F 值均优于注入组（PPPPP结论 PS 稀释后进行气管内灌洗在改善通气和氧合方面优于PS 气管内注入,并可减少上机时间,减少并发症,提高治愈率。     

肺表面活性物质治疗新生儿重症胎粪吸入综合征的疗效评价

目的评价外源性肺表面活性物质(PS)治疗重症胎粪吸入综合征(MAS)的疗效。方法将43例重症MAS病例随机分成两组,20例作治疗组,在上呼吸机及常规治疗同时应用PS治疗;23例患儿作对照组,予呼吸机及常规治疗,观察监测两组患儿的肺氧合功能、病程及预后。结果治疗后的不同时期,治疗组患儿的氧合指数低于对照组,差异有显著性(P<0.05);动脉/肺泡氧分压比值(a/APO2)高于对照组,差异有显著性(P<0.05);治疗组机械通气时间、用氧时间和住院时间均显著少于对照组(P<0.05)。结论PS治疗能有效地改善MAS患儿的肺氧合功能,可缩短应用机械通气及用氧的时间及病程。     

肺表面活性物质治疗新生儿胎粪吸入综合征的临床研究

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。     

肺表面活性物质治疗新生儿胎粪吸入综合征临床疗效的meta分析

目的：外源性肺表面活性物质(PS)治疗胎粪吸入综合征(MAS)的临床疗效存在争议,本研究对PS治疗MAS的效果进行系统评价,为其临床应用提供循证医学证据。方法：计算机检索PubMed、Science Citation Index、The Cochrane Central Register of Controlled Trials、Ovid、EBSCOhost、BIOSIS previews、中国生物医学文献数据库、万方数据库、维普中文科技期刊数据库关于PS治疗MAS的随机对照试验（RCT）。根据Cochrane系统评价员手册5.0.2版方法评价文献质量,采用RevMan 5.0.25软件进行meta分析。结果：共纳入8个RCT,包含512例MAS患儿,其中PS治疗组257例,对照组255例。Meta分析显示,PS治疗MAS,能显著降低氧合指数（MD=-2.59,95%CI：-4.33~-0.86,P=0.003）,升高动脉/肺泡氧分压比值（MD=0.05,95%CI：0.05~0.06,P<0.00001）,缩短平均住院时间（MD=-4.94,95%CI：-7.44~-2.44,P=0.0001）和降低病死率（OR=0.47,95%CI：0.24~0.93,P=0.03）。而机械通气时间、氧疗时间、气漏发生率、肺出血发生率、颅内出血发生率两组间差异无统计学意义。结论：目前证据显示PS替代治疗MAS 是有效的,但鉴于该meta分析纳入文献数量有限且质量中等,结论尚需规范的大规模、多中心RCT论证。     

Advances in the treatment of the meconium aspiration syndrome

Meconium aspiration syndrome (MAS) is a common cause of respiratory distress in neonates. In many affected children, the complex nature of meconium aspiration syndrome contributes to the apparent lack of response to standard therapies. Over the past decade, several new therapies have been suggested to be more effective than "conventional" management in treating meconium aspiration syndrome. These include: anti-inflammatory drugs, medications to counter the effect of prostaglandin-related compounds, high-frequency ventilation, exogenous surfactant, inhaled nitric oxide and liquid ventilation. There are, however, scant evidence-based data to justify routine use of any of those therapies. Additional prospective, well-controlled, randomized trials of diverse therapies are needed to elucidate the optimum management of MAS.     

猪肺表面活性物质联合布地奈德混悬液气管内滴入治疗新生儿胎粪吸入综合征的疗效观察

目的探讨猪肺表面活性物质(PS)联合布地奈德混悬液气管内滴入治疗新生儿胎粪吸入综合征(MAS)的临床效果。方法采用前瞻性研究法,将70例MAS新生儿随机分成治疗组与对照组(n=35)。对照组常规给予气管内滴入PS(100 mg/kg)治疗,治疗组在此基础上加用布地奈德(0.25 mg/kg)治疗。结果治疗组在治疗后12 h需重复使用PS的比例明显低于对照组(P0.05)。治疗组在治疗后6 h、12 h、24 h动脉氧分压与吸入氧浓度比值(Pa O_2/Fi O_2)、经皮血氧饱和度(Tc Sa O_2)、动脉血氧分压(Pa O_2)、动脉血二氧化碳分压(Pa CO_2)的改善情况明显优于对照组(P0.05)。治疗后48 h胸片显示治疗组肺部炎症吸收明显优于对照组(P0.05);治疗组并发症的发生率明显低于对照组(P0.05),平均住院时间也较对照组明显缩短(P0.01)。结论与单用PS比较,PS联合布地奈德混悬液气管内滴入治疗新生儿MAS能更好改善血气指标和临床症状,缩短住院时间,减少并发症。     

Intratracheal catheter suction removes the same volume of meconium with less impact on desaturation compared with meconium aspirator in meconium aspiration syndrome

Objective

To evaluate the impact of suction technique on the rate of meconium removal, oxygenation, and hemodynamics in an animal experimental model of meconium aspiration syndrome (MAS).

Methods

MAS was induced in ventilated rabbits using 3.5 ml/kg of 20% human meconium. Tracheal suction with either catheter suction (CS) or meconium aspirator (MA) was performed after meconium instillation. Percentage of meconium collection rate, PaO₂ trends for 2 h after tracheal suction, and acute-phase SpO₂ trends were compared between CS and the other three groups, the tube was withdrawn while meconium was aspirated with an MA, then the trachea was reintubated 5, 10 or 15 s after suctioning of meconium.

Results

Percentage of meconium collection rate and PaO₂ showed no significant differences between groups. The MA group taking 15 s for reintubation after meconium suctioning, showed a significantly lower acute-phase SpO₂ than the CS group (P < 0.05). The time for SpO₂ to return to ≥ 90% was also longer in the MA group taking 15 s for reintubation than in the CS group (P < 0.05).

Conclusion

Intratracheal CS removed the same volume of meconium with less impact on desaturation compared with meconium aspiration in an animal model of MAS. Intratracheal CS may be benefit to remove meconium in non-vigorous infants with meconium-stained amniotic fluid at birth.     

肺表面活性物质治疗新生儿胎粪吸入综合征的系统评价

目的评价肺表面活性物质(PS)治疗新生儿胎粪吸入综合征(MAS)的疗效和安全性。方法检索Cochrane图书馆、PubMed、EMBASE、CBMdisc、CNKI、VIP等,检索时间均从建库至2008-12-31,对同质资料进行Meta分析。结果共纳入11项研究(605例)。Meta分析结果示:(1)PS与安慰剂或空白对照,病死率、气胸发生率、气漏发生率、慢性肺疾病发生率、脑室内出血发生率、机械和辅助通气供氧天数差异均无统计学意义,住院天数和需要人工体外膜氧合法差异有统计学意义。(2)应用机械通气联合PS与机械通气对照,病死率、气漏发生率、机械及通气供氧天数、住院天数、治疗后12h和24h氧合指数(OI)及动脉/肺泡氧分压比值(a/APO2)差异有统计学意义;但脑室内出血发生率、OI(治疗前)和a/APO(2治疗前)差异均无统计学意义。结论PS的疗效及安全性并不优于安慰剂或空白对照;机械通气联合PS的疗效和安全性要优于机械通气,由于纳入研究存在偏倚的可能性,有必要进一步开展高质量随机对照试验,评价其疗效和安全性。     

Wheezy baby syndrome—A possible sequelae of neonatal meconium aspiration syndrome

Forty children aged 5 months to 3 years and suffering from wheezy baby syndrome (WBS) were evaluated to find out the prevalence of neonatal meconium aspiration syndrome (MAS) from the birth records. Twelve (30%) babies with WBS were detected to have a history of MAS at birth, significant enough to require a neonatal ICU admission. In contrast, only 2% of the 50 control non wheezy babies aged 6 months-3 years had a history of neonatal meconium aspiration syndrome (p<0.001). There was no significant difference in mean number of wheezing spells over six months in the neonatal MAS positive and MAS negative groups (3.4 vs 3.2, p>0.05). Family history of atopy was present in 64.3% of wheezing subjects with normal birth records, while none had such history in babies with neonatal MAS. The results of the present study suggested an association between neonatal MAS and subsequent wheezing.     

Steroids in full term infants with respiratory failure and pulmonary hypertension due to meconium aspiration syndrome

Persistent pulmonary hypertension of the newborn (PPHN) due to meconium aspiration syndrome (MAS), has a high morbidity and mortality especially in centres with limited access to extra-corporeal membrane oxygenation or nitric oxide therapy. In such a setting, we conducted a pilot study to evaluate the effect of dexamethasone on severe respiratory failure with PPHN due to MAS with a view to exploring possible justification for randomised controlled trials in similar patients. We prospectively managed a consecutive case series of 14 infants over a 3-year period with the above mentioned diagnosis, who were ventilated and with an oxygenation index >25. Dexamethasone was commenced in a dose of 0.5 mg/kg per day and given for up to a maximum of 9 days in a reducing schedule. Differences between time points were analysed using analysis of variance for repeated measures. The mean age of commencing dexamethasone was 79.9 h. There was a rapid, significant improvement (P < 0.05) in the respiratory status in 13 of these infants after commencing dexamethasone, allowing weaning from the ventilator and eventual extubation at a mean age of 8.7 days. One infant died. Two infants had infective episodes. Conclusion Dexamethasone, if started early in infants with respiratory failure and persistent pulmonary hypertension of the newborn due to meconium aspiration syndrome may be effective in improving gas exchange, and possibly avoiding extra-corporeal membrane oxygenation. A randomised controlled trial of using dexamethasone early in similar patients and setting is warranted. Received: 18 May 2000 / Accepted: 13 September 2000     

高频振荡通气联合肺表面活性物质治疗新生儿重型胎粪吸入综合征并发肺出血的临床研究

目的 探讨高频振荡通气 （HFOV）联合肺表面活性物质 （PS）治疗新生儿重型胎粪吸入综合征 （MAS）并发肺出血 （NPH）的有效性及安全性。方法 选取重型MAS并发NPH患儿48例,回顾性分析HFOV+PS （试验组,n=25）和单纯HFOV （对照组,n=23）治疗的临床疗效,比较两组患儿的血气分析、氧合指数 （OI）、PaO2/FiO2 （P/F）值、肺出血时间、呼吸机治疗时间、住院时间、并发症及转归变化。结果 试验组治疗后6、12、24、48h的PaO2、OI值及P/F值均要优于对照组 （P < 0.05）;试验组的呼吸机治疗时间、NPH时间较对照组明显缩短 （P < 0.05）;试验组住院时间、并发症和治愈率与对照组相比差异无统计学意义。结论 HFOV联合PS能更好地改善患儿氧合功能,缩短NPH时间和呼吸机治疗时间,未增加不良反应的发生率,是安全、有效的治疗方法。     

胎粪吸入综合征新生儿脑组织氧饱和度的研究

目的：探讨胎粪吸入综合征(MAS)不同时相对新生儿局部脑组织氧饱和度(regionaloxygensatu-ration,rSO2)的影响因素及合并缺氧缺血性脑病时脑组织氧饱和度变化的意义。方法：根据MAS的临床表现分为无症状型、普通型、重型。应用TSNIR-3无创组织氧监测仪,测定其出生后1,3,5,7d时的脑组织氧饱和度变化,并与正常足月新生儿进行比较。结果：MAS无症状型与正常对照组的rSO2在出生后第1天(58.37±4.12vs60.43±2.85)、第3天(57.76±2.33vs60.17±3.46)比较差异有显著性(P<0.05);MAS普通型、重型生后的第1,3,5天时脑组织rSO2明显降低,MAS重型、普通型与无症状型、正常对照组的rSO2在出生后第1,3,5天比较差异有显著性(P<0.05)。MAS合并轻度HIE组与中~重度HIE组比较,rSO2在发病的第1天差异无显著性意义(P>0.05),第2,3,5天比较(57.60±3.60vs53.36±4.48;55.60±2.35vs51.36±3.20;56.80±2.78vs53.22±5.10)差异均有显著性意义(P<0.05)。结论：MAS患儿在生后的不同时相脑组织rSO2受到不同程度的影响,缺氧的加重和持续时间增加可使脑氧合功能进一步损害。     

重度胎粪吸入综合征并发急性呼吸窘迫综合征临床特征及转归分析

目的 探讨新生儿重度胎粪吸入综合征(meconium aspiration syndrome,MAS)并发急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床特征及转归,为临床诊治提供参考.方法 回顾性收集2017年1月至2019年12月收治的60例重度MAS新生...     

胎粪吸入综合征及并发持续肺动脉高压的肺机制研究

目的 探讨胎粪吸入综合征（ＭＡＳ）及并发持续肺动脉高压（ＰＰＨＮ）患儿的肺功能变化。方法 应用美国Ｂｉｃｏｒｅ公司的ＣＰ－１００新生儿肺功能监护仪检测２０例ＭＡＳ患儿的肺功能,结果 ＭＡＳ患儿呼吸频率（ＲＲ）为（８３±１５）次／ｍｉｎ,气道阻力（ＡＲ）为（１０８±４６）ｃｍＨ２Ｏ（Ｌ·ｓ）。比对照组的（４５±６．０）次／ｍｉｎ（３８±１７）ｃｍＨ２Ｏ／（Ｌ·ｓ）明显增高（ｔ＝２．３０,２．５１,Ｐ     

Effect of surfactant lavage in a rabbit model of meconium aspiration syndrome

Meconium aspiration syndrome (MAS) is a frequent cause of respiratory distress in neonates. Recent reports have suggested that surfactant dysfunction contributes to the pathophysiology of MAS and surfactant therapy improves oxygenation of infants with MAS. We evaluated the effect of bronchial lavage with surfactant solution in a rabbit model of meconium aspiration. All animals were given 5 mL/kg of a 20% slurry of human meconium into the endotracheal tube and mechanically ventilated. The animals were then divided into saline lavage (n = 5) or surfactant lavage (n = 5). Lavage was performed an hour after meconium instillation. After the lavage the total amount of meconium recovered was measured. Blood gas was monitored during the experiment. The amount of meconium recovered by saline lavage was 14%, and by surfactant lavage was 57%. The surfactant group had a significant improvement in gas exchange, whereas the saline group had no improvement. It was concluded that the lavage with surfactant solution effectively washed out meconium and improved gas exchange in rabbit model of MAS.     

高频震荡通气联合一氧化氮治疗重症胎粪吸入综合征

目的 探讨高频震荡通气(high frequency oscillatory ventilation,HFOV)联合吸入一氧化氮(inhaled nitric oxide,iNO)治疗重症新生儿胎粪吸入综合征(meconium aspiration syndrome,MAS)的临床疗效.方法 2008年10月至2011年5月期间入住我科的60例重症MAS患儿,出生后均需机械通气治疗,上机前氧合指数(oxygenation index,OI)均＞30.根据通气模式的不同,将60例患儿随机分为HFOV组、常频通气(conventional mechanical ventilation,CMV)组和HFOV+ iNO组,每组各20例,并比较3组的疗效,包括OI值、肺气漏及肺动脉高压的发生率.结果 机械通气治疗24h后,HFOV组及HFOV+ iNO组患儿较CMV组OI值明显降低(19.0±4.5 vs 11.0±5.3 vs 25.0±7.1,P＜0.05),并且HFOV+ iNO组在治疗4h后OI即出现明显下降(36.0±7.4至24.0±5.2).CMV组患儿肺气漏发生率为25％(5/20),HFOV组及HFOV+ iNO组均无肺气漏发生;HFOV组肺动脉高压发生率为30％(6/20),CMV组肺动脉高压发生率为40％(8/20),HFOV+ iNO组无一例发生肺动脉高压.结论 HFOV联合iNO是治疗重症MAS首选机械通气策略,两者合用疗效最佳.