肺表面活性物质治疗急性呼吸窘迫综合征的若干问题

肺表面活性物质(PS)缺乏和灭活与急性呼吸窘迫综合征(ARDS)的发病有关。外源性PS治疗ARDS已有许多研究,但其疗效文献报道相差较大。作者阐述PS异常的机制及其在ARDS发病中的地位和作用,常用PS制剂,并重点分析影响PS疗效的若干因素。     

肺表面活性物质治疗急性呼吸窘迫综合征的若干问题

肺表面活性物质缺乏和灭活与急性呼吸窘迫综合征的发病有关。外源性ＰＳ治疗ＡＲＤＳ已有许多研究，但其疗效献报道相差较大。作阐述了ＰＳ异常的机制及其在ＡＲＤＳ发病中的地位和作用，常用ＰＳ制剂，产重点分析影响ＰＳ疗效的若干因素。     

肺表面活性物质治疗呼吸窘迫综合征临床应用进展

1980年滕原用人工合成的肺表面活性物质(PS)治疗未成熟儿呼吸窘迫综合征(RDS)取得了良效,以后迅即在世界范围内研究和应用,展示了广阔的前景。近年来,我国已有报告自制PS治疗新生儿型和获得性RDS(NRDS、ARDS)。现作一综述。 一、PS的成分、制剂和用法 1986年Yu报告PS中磷脂占80％、中性脂肪10％、蛋白质10％。     

肺表面活性物质在急性肺损伤/急性呼吸窘迫综合征中的研究进展

急性肺损伤／急性呼吸窘迫综合征（ALI／ARES）时肺表面活性物质的成分、功能等均发生变化，研究这些变化对防治ALI／ARDS的发生、发展及预后，都有十分重要的意义。本文综述了肺表面活性物质在ALI／ARDS中的组成成分、代谢、功能改变以及治疗方面的研究进展，为该领域的深入研究提供参考。     

肺表面活性物质治疗足月新生儿急性呼吸窘迫综合征疗效分析

目的探讨肺表面活性物质治疗足月新生儿急性呼吸窘迫综合征的临床疗效。方法选择该院2015-02~2016-04收治的74例足月新生儿急性呼吸窘迫综合征患儿为研究对象,按随机数字表法分为观察组和对照组各37例。对照组接受常规疗法,观察组在对照组基础上加用肺表面活性物质治疗。对两组患儿疗效及治疗前与治疗后24 h血气指标进行观察比较。结果观察组显效15例,有效20例,无效2例。对照组显效9例,有效19例,无效9例。观察组疗效优于对照组(P0.05)。治疗前,两组患者血气分析指标无明显差异(P0.05),治疗后观察组血氧分压(Pa O2)、二氧化碳分压(Pa CO2)、p H值均优于对照组,差异有统计学意义(P0.01)。结论肺表面活性物质应用于足月新生儿急性呼吸窘迫综合征治疗中效果显著,能快速改善血气指标,值得临床推广。     

新生儿呼吸窘迫综合征早期应用肺表面活性物质治疗的观察

目的探讨肺表面活性物质对新生儿呼吸窘迫综合征(NRDS)的治疗效果。方法将100例NRDS患儿随机分为治疗组50例和对照组50例,两组均给予机械通气等常规治疗,治疗组在此基础上给予气管内滴入肺表面活性物质,剂量为100 mg/kg。结果治疗组存活率高于对照组,(P<0.05);治疗组通气时间明显低于对照组(P<0.05);治疗组治疗后血气分析与对照组同项比较,(P均<0.05或<0.01);治疗组治疗后各时段机械通气参数FiO2、VEI、MAP与对照组同项比较,(P均<0.05或<0.01)。结论肺表面活性物质对NRDS疗效满意,值得推广。     

足月新生儿急性呼吸窘迫综合征采用肺表面活性物质治疗的临床报道

目的研究分析足月新生儿急性呼吸窘迫综合征采用肺表面活性物质治疗的临床效果。方法选取我院在2009年1月1日至2013年1月1日收治的184例足月新生儿急性呼吸窘迫综合征患者的临床资料进行研究分析,并随机将其分为治疗组(93例)和对照组(91例),对照组患者采用氨溴索进行治疗,治疗组患者采用固尔苏进行治疗,对比两组患者临床治疗效果。结果对比两组患者临床治疗效果,治疗组患者临床治疗总有效率(90.32%)显著优于对照组患者的(70.33%),有统计学意义(P0.05)。结论肺表面活性物质对足月新生儿急性呼吸窘迫综合征患者具有显著效果,可有效改善患者临床症状。     

肺表面活性物质联合辅助通气治疗足月新生儿急性呼吸窘迫综合征疗效观察

目的：观察肺表面活性物质联合辅助通气治疗足月新生儿急性呼吸窘迫综合征（ ARDS ）的临床疗效。方法87例ARDS新生儿,按治疗方法不同分为观察组43例、对照组44例。观察组行常规辅助通气＋肺表面活性物质治疗,对照组行常规辅助通气治疗。对比两组治疗24 h后PaO2、PaCO2、PaO2／FiO2水平及X线胸片变化,评价疗效。结果两组治疗后PaO2、PaCO2、PaO2／FiO2水平均改善,观察组改善效果均优于对照组,P均＜0．05。观察组治愈14例、有效26例,总有效率为93．02％;对照组治愈10例、有效21例,总有效率为70．45％;P＜0．05。结论肺表面活性物质联合辅助通气可有效改善ARDS新生儿症状及血气分析指数。     

肺表面活性物质治疗早产儿呼吸窘迫综合征给药时间的研究概况

肺表面活性物质(pulmonary surfactant,PS)已常规用于新生儿呼吸窘迫综合征的防治,其疗效肯定,并有大量文献报道其使用效果、给药方式、使用剂量等临床研究。但关于PS最佳给药时间的研究不多,给药时间与给药目的紧密相关,主要有早期的预防性给药、中期的替代治疗抢救性给药、晚期的挽救性给药和重复给药,因我国医疗发展的客观条件、治疗理念差别等因素在使用PS的时间界点上各有报道,该文对PS治疗早产儿呼吸窘迫综合征给药时间的研究情况作一概述。     

Lodixanol inhibits exogenous surfactant therapy in rats with acute respiratory distress syndrome.

Optimal alveolar distribution of exogenous surfactant is an important determinant of its beneficial effect. This distribution can be determined by suspending surfactant in a radiological contrast medium before intratracheal instillation, followed by radiological imaging. Iodixanol is reported to be a safe contrast medium that causes no lung injury when instilled intratracheally. In this study, the effects of surfactant suspended in saline were compared with surfactant suspended either in 4:1 saline-iodixanol (64 mg iodine x mL(-1)) or in 1:1 saline-iodixanol (160 mg iodine x mL(-1)), on oxygenation and lung mechanics in a rat model of adult respiratory distress syndrome (ARDS) induced by lung lavage. After the induction of ARDS, surfactant instillation improved oxygenation, total lung volume at inflation with a distending pressure of 35 cmH2O, lung volume at transpulmonary pressure of 5 cmH2O and Gruenwald index. The effects of surfactant suspended in 4:1 saline-iodixanol were similar to those of surfactant alone. However, instillation of surfactant suspended in 1:1 saline-iodixanol resulted in significantly lower values in all measured parameters. Surface tension was the lowest in surfactant suspended in saline alone and addition of iodixanol led to an increase in surface tension in a dose-dependent manner. In conclusion, iodixanol at the higher dose caused an inhibition of the exogenous surfactant effect, characterized as a lack of improvement in oxygen tension in arterial blood, low total lung compliance, volume at 5 cmH2O end-expiration and Gruenwald index. This effect of iodixanol was probably due to its high surface tension, especially if a high concentration was used. Surfactant suspended in a lower concentration of iodixanol seems a better alternative, allowing for radiological imaging of the distribution of surfactant when intratracheally instilled.     

Treatment of acute respiratory distress syndrome with recombinant surfactant protein C surfactant

We performed a phase I/II trial in North America of a recombinant surfactant protein C-based surfactant (Venticute) as treatment for the acute respiratory distress syndrome. Patients were prospectively randomized to receive either standard therapy or standard therapy plus one of two doses of exogenous surfactant given four times over 24 hours. Surfactant administration was well tolerated. No significant treatment benefit was associated with surfactant treatment. Bronchoalveolar lavage of treated patients at 48 hours reflected the presence of exogenous surfactant components, did not show evidence of improved surface tension lowering function, and had interleukin-6 concentrations that were significantly lower than control group values, consistent with an antiinflammatory treatment effect. The presence of exogenous surfactant was not detected in lavage fluid obtained at 120 hours. Future studies might rationally employ larger surfactant doses and a more prolonged dosing schedule.     

肺表面活性物质预防早产儿呼吸窘迫综合症的临床观察

目的对肺表面活性物质固尔苏应用于早产儿呼吸窘迫综合症的早期预防效果进行观察及分析。方法选取早产儿病例120例,根据患儿家长意愿分组为固尔苏组62例和对照组58例。在常规进行心电监测、入恒温箱、抗感染等治疗基础上,对照组不应用固尔苏,固尔苏组给予固尔苏用药治疗。结果固尔苏组患儿的平均通气时间、氧疗时间和住院时间明显短于对照组(P0.01);固尔苏组患儿呼吸机相关性肺炎、肺气漏和视网膜病变发病率明显低于对照组(P0.05);固尔苏组患儿治愈率明显高于对照组,致死率和NRDS发生率明显低于对照组(P0.01)。结论肺表面活性物质预防早产儿呼吸窘迫综合症具有较好的疗效,可快速改善患儿肺功能、提高肺顺应性,并且降低并发症的发生以及致死率。     

高频震荡通气治疗先天性心脏病术后重症ARDS32例效果观察

目的探讨高频震荡通气(HFOV)对小儿心脏手术后重症ARDS的治疗效果。方法对32例心脏手术后常频通气(CMV)治疗无效的重症ARDS患儿行HFOV治疗,设置相应的参数并行氧合、通气管理,每次吸痰后行肺复张。观察治疗前后血气指标变化、HFOV治疗时间、肺复张期间循环指标变化、整体治疗期间并发症发生情况及患儿存活情况。结果 HFOV治疗后通气及气体交换在较短的时间内改善,12～48 h血气相关指标PaO2、PaCO2、吸入氧浓度(FiO2)、氧合指数(PaO2/FiO2)均明显改善且稳定。HFOV治疗时间43～238(128.5±67.49)h,肺复张期间循环指标未出现异常变化,末梢血氧饱和度快速恢复至吸痰前水平,呼吸机的吸氧浓度快速降低。整体治疗期间出现气胸9例,均安置胸腔闭式引流。本组患儿存活21例(65.6%),死亡11例。结论 HFOV对CMV治疗无效的重症ARDS能在较短时间内改善通气及气体交换,可作为小儿心脏术后重症ARDS的重要抢救措施。     

Rapid improvement of static compliance after surfactant treatment in preterm infants with respiratory distress syndrome

Respiratory mechanics were measured in 20 preterm infants before and in the 24-hr period after treatment with surfactant. All infants were enrolled in the rescue clinical trial with Curosurf® carried out in the Neonatal Intensive Care Unit. They received a dose of 200 mg/kg lipid surfactant intratracheally after birth. Static compliance of the respiratory system (C_rs) was measured by the single breath occlusion technique during both spontaneous and mechanical ventilation. Resistance of the respiratory system (R_rs) and expiratory time constant (T_rs) were also measured. As early as 3 hr after surfactant administration a significant improvement of 45% in Crs measured during mechanical ventilation (C_rsV) was noted (0.40 ± 0.14 vs 0.58 ± 0.17 mL/cm H₂O/kg, P < 0.001), together with a significant improvement of the arterial/alveolar O₂ tension ratio (Pa/Ao₂) (0.12 ± 0.03 vs 0.30 ± 0.16. P < 0.01). The improvement of C_rsV and Pa/Ao₂ was confirmed 24 hr later (0.55 ± 0.15 mL/cm H₂O/kg and 0.33 ± 0.18, respectively). A significant correlation was found between C_rs and P_a/Ao₂ ratio (r = 0.56, P < 0.001). Time constant values were significantly higher after surfactant treatment (0.15 ± 0.07 vs 0.09 ± 0.03 sec; P < 0.01). R_rs remained unchanged. These data indicate that Curosuf® given intratracheally after birth determines a rapid improvement of respiratory mechanics as soon as 3 hr after dosing, together with the improvement of oxygenation. From the findings obtained with the present study we show evidence that respiratory system mechanics may be a useful physiological measure to guide ventilatory strategy following surfactant therapy. © 1993 Wiley-Liss, Inc.     

Bronchoscopic instillation of surfactant in acute respiratory distress syndrome

Abnormalities of surfactant action in acute respiratory distress syndrome (ARDS) result in decreased lung compliance and significant hypoxemia. Several case reports and small studies suggest that there is an improvement in patients with ARDS following the administration of surfactant. However, there is no clear-cut ideal method for surfactant administration. The bronchoscopic administration of surfactant may represent an effective method of surfactant delivery in ARDS. Bronchoscopic instillation offers the theoretical advantages that the surfactant may be distributed directly to the desired regions of the lung, a more economical use of surfactant, and the opportunity to lavage leaked serum proteins prior to instillation. Surfactant has been administered in adults with success. We present a case of initial improvement in oxygenation index, ventilation index, and mechanical ventilatory support in a pediatric patient with ARDS following the bronchoscopic administration of surfactant.     

不同剂量国产牛肺表面活性物质治疗早产儿呼吸窘迫综合征疗效观察

目的评价不同剂量国产牛肺表面活性物质治疗早产儿呼吸窘迫综合征临床疗效及安全性。方法采用国产牛肺表面活性物质三种剂量治疗早产儿呼吸窘迫综合征的患儿,其中符合入选标准研究对象共93例。随机分为小剂量组(40-70 mg/kg,31例)、中剂量组(70-100 mg/kg,31例)和大剂量组(100-140 mg/kg,31例),比较三组患儿用药前后血气分析(p H,Pa O2,Pa CO2)的变化情况,记录三组患儿的性别、胎龄、出生体重、分娩方式、Apgar评分、羊水情况、有无胎膜早破、需重复用药例数、需机械通气例数、需机械通气时间、氧疗时间、住院天数、转归、并发症及平均住院费用等,进行统计分析。结果三组患儿比较性别、胎龄、出生体重、分娩方式、Apgar评分、羊水情况、有无胎膜早破等差异均无统计学意义(P0.05)。三组患儿首次应用肺表面活性物质治疗6 h后p H值及Pa O2均有不同程度升高、Pa CO2均有不同程度降低,与治疗前比较差异均有统计学意义(P0.05)。治疗前三组之间p H值、Pa O2及Pa CO2差异均无统计学意义(P0.05)。三组患儿之间比较治疗效果(需重复用药例数、需机械通气例数、需机械通气时间、氧疗时间)的差异均无统计学意义(P0.05)。三组之间比较并发症发生率及治愈率差异均无统计学意义(P0.05)。三组患儿之间比较平均住院天数及平均住院费用的差异有统计学意义(P0.05),中剂量组与大剂量组比较患儿的平均住院费用减少,与小剂量组比较患儿的平均住院天数减少。结论三种剂量国产牛肺表面活性物质治疗早产儿呼吸窘迫综合征均具有相似的临床疗效及安全性,但中剂量组与大剂量组比较可有效降低患儿的平均住院费用,与小剂量组比较可有效减少患儿的平均住院天数。     

肺表面活性物质治疗呼吸窘迫综合症疗效观察

目的 观察肺表面活性物质（PS）在治疗足月儿和近足月儿呼吸窘迫综合症治疗中的作用;方法分析我院应用 PS 替代疗法救治患有呼吸窘迫综合症的足月和近足月新生儿21例的疗效;结果给予肺表面活性物质治疗后6 h、12 h、24 h 两组患儿的氧合及通气功能（PaO2、PaCO2）明显改善（P〈0.05）,主要呼吸机参数（PIP、PEEP、FiO2）等指标均明显降低,21例患儿中19例有效,有效率90.4%,未见明显不良反应;结论肺表面活性物质替代治疗可以改善足月儿和近足月儿呼吸窘迫综合症的疗效,降低机械通气治疗时间,减少并发症.