Objective To evaluate the clinical effect of endotracheal lavage with porcine pulmonary surfactant (PS) in term neonates with severe meconium aspiration syndrome (MAS). Methods A total of 136 full-term infants with severe MAS who were admitted to the neonatal intensive care unit between January 2010 and June 2013 were randomly and equally divided into PS lavage and PS injection groups. In the PS lavage group, patients were treated with endotracheal lavage using 3-5 mL of diluted PS (12 mg/mL) each time, and the PS injection group was given PS by intratracheal injection at the first dose of 200 mg/kg. Blood gas, oxygenation index (OI), and PaO2/FiO2 (P/F) of the two groups were evaluated before and 2, 12, 24, and 48 hours after the treatment, and the duration of mechanical ventilation, complication rate, and cure rate were compared between the two groups. Results Compared with the PS injection group, the PS lavage group had significantly higher PaO2 and P/F ration and significantly lower PaCO2 and OI at 12, 24, and 48 hours post-treatment (P<0.01), a significantly shorter duration of mechanical ventilation (P<0.01), a significantly smaller amount of PS (P<0.01), a significantly lower complication rate (P<0.05), and a significantly higher cure rate (97% vs 88%; P<0.05). Conclusions Compared with the intratracheal injection of PS, endotracheal lavage with diluted PS in term neonates with severe MAS can increase ventilation and oxygenation efficiency, shorten the duration of mechanical ventilation, reduce the complication rate, and increase the cure rate, indicating that this method is a safe and effective therapeutic strategy.
Key words
Meconium aspiration syndrome /
Pulmonary surfactant /
High-frequency oscillatory ventilation /
Neonate
References
[1] Cleary G, Wiswell M. Meconium-stained amniotic fluid and the meconium aspiration syndrome an update[J]. Pediatr Clin North Am, 1998, 45(5): 511-529.
[2] 新生儿呼吸疾病研究协作组. 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[J]. 中华儿科杂志, 2005, 43(5): 354-359.
[3] 杜立中. 吸入综合征[M]//邵肖梅, 叶鸿瑁, 邱小汕. 实用新 生儿学. 第4 版. 北京: 人民卫生出版社, 2011: 398-401.
[4] Wiswell TE. Advances in the treatment of meconium aspiration syndrome[J]. Acta Paediatr Suppl, 2001, 436(1): 28-30.
[5] Greenough A, Milner AD. 急性呼吸道疾病[M]//Rennie JM (刘 锦纷主译). 罗伯顿新生儿学. 北京: 北京大学医学出版社, 2009: 550-557.
[6] 中华医学会儿科学分会新生儿学组. 中国住院新生儿流行病 学调查[J]. 中国当代儿科杂志, 2009, 11(1): 15-30.
[7] Chinese Collaborative Study Group for Neonatal Rspiratory Diseases. Treatment of severe meconium aspiration with porcine surfactant: a multicentre, randomized, controlled trial[J]. Acta Paediatrica, 2005, 94(7): 896-902.
[8] Ohana Y, Ogawa Y. Treatment of meconium aspiration syndrome with surfactant lavage in an experimental rabbit model[J]. Pediatr Pulmonol, 1999, 28(1): 18-23.
[9] Lan BC, Yeung CY. Surfactant lavage for meconium aspiration syndrome a pilot study[J]. Pediatrics, 1999, 103(10): 1014-1018.
[10] Cochrane CG, Revak SD, Merritt TA. Bronchial lavage with KL4-surfactant in models of meconium aspiration syndrome[J]. Pediatr Res, 1998, 44(6): 705-715.
[11] Dargaville PA, Mills JF, Hendley BM. Therapeutic lung lavage in the piglet model of meconium aspiration syndrome[J]. Am J Respir Crit Care Med, 2003, 168(4): 456-463.
[12] 陈超. 肺表面活性物质在新生儿肺部疾病中的应用进展[J]. 中国实用儿科杂志, 2003, 18(11): 651-654.
[13] 罗菲菲, 杨迪元, 陈攀, 等. 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[J]. 中国当代儿科杂志, 2012, 14(6): 413-417.
[14] Wiswell TE, Knight GR, Finer NN. A multicenter randomized controlled trial comparing surfaxin(Lucinactant) lavage with standard care for treatment of meconium aspiration syndrome[J]. Pediatrics, 2002, 109(10): 1081-1087.
[15] 杨彤, 沈琪, 黄献文. 肺表面活性物质治疗新生儿胎粪吸入 综合征的系统评价[J]. 中国实用儿科杂志, 2010, 25(3): 220-226.
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