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題名 | Small Versus Large Volume Dilute Surfactant Lavage for Meconium Aspiration Syndrome=稀釋兩種不同體積之表面張力素對胎便吸入症候群作氣管灌洗之比較 |
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作者姓名(中文) | 洪漢陽; 詹偉添; 許瓊心; 張瑞幸; 彭純芝; 施焄鏻; 張弘洋; 高信安; | 書刊名 | 臺灣兒科醫學會雜誌 |
卷期 | 47:4 民95.07-08 |
頁次 | 頁181-186+214 |
分類號 | 417.517 |
關鍵詞 | 表面張力素灌洗; 胎便吸入症候群; 平均氣道壓力; Surfactant lavage; Meconium aspiration syndrome; Mean airway pressure; |
語文 | 英文(English) |
中文摘要 | 背景:使用稀釋之表面張力素作氣管內灌洗治療新生兒之胎便吸入症候群,已証實為有效方法。方法:自2002年8月至2005年7月間,我們對所有發生胎便吸入症候群且必須使用呼吸器之新生兒共11 例,以稀釋較小體積表面張力素共20cc(其phospholipid濃度為10mg/dl)作氣管內灌洗。並針對先前發生同樣疾病及條件之9個新生兒,但以稀釋較大體積表面張力素共40cc(其phospholipid濃度為5mg/dl)作氣管內灌洗作比較。結果:其結果發現以稀釋較大體積表面張力素灌洗(Large Volume Lavage, LVL)組中,平均體重較以稀釋較小體積表面張力素灌洗(Small Volume Lavage, SVL)組為重(3.29±0.36 vs 2.92±0.4 kg, P=0.04)及LVL組所需之灌洗時間也較SVL組為長(48.89±7.41 vs. 30.91±5.83 mins, P<0.001)。而兩組,共20個新生兒,以稀釋表面張力素灌洗前後所測量之氧和數值,包括:平均動脈氧氣分壓、氧和指標及肺泡與動脈氧氣分壓比率作比較發現,均在灌洗後6小時起得到統計上顯著改善,但兩組間並無顯著差異。對於因灌洗而導致副作用發生的比較,LVL組內有3個個案發生暫時性缺氧及5個案在胸部X光中有顯示white out影像,這在SVL組中並未發現。而且,LVL組之平均氣道壓力比SVL組為高(16.0±2.65 vs 13.3±3.01 cmH2O, P=0.046)。結論:以小體積稀釋表面張力素對新生兒發生胎便吸入症候群作氣管內灌洗,具有如使用以大體積稀釋表面張力素作氣管內灌洗相同好處。並且,能降低以稀釋表面張力素作氣管內灌洗之副作用發生。 |
英文摘要 | Background: Surfactant lavage has been used to treat neonatal meconium aspiration syndrome (MAS). Objective: To assess the effects of lavage with a small volume of dilute surfactant in neonates with MAS, and compare the results with those of historical controls treated with larger volumes. Methods: From August 2002 to June 2005, we treated 11 newborns with MAS using 20 ml of dilute surfactant at a phospholipid concentration of 10 mg/ml (SVL group). We compared the results with those of 9 infants previously treated with large-volume lavage (LVL group), using 40 ml of dilute surfactant, 5 mg/ml. Results: Both groups were similar at baseline except for a higher mean birth weight in the LVL group (3.29±0.36 vs 2.92±0.4 kg, P=0.04). The lavage procedure was longer in the LVL than the SVL group (48.89±7.41 vs. 30.91±5.83 mins, P<0.001). Measures of oxygenation, including mean PaO2, oxygenation index, and arterial/alveolar O2 ratio, showed no significant difference between the two groups. Adverse events in the LVL group included transient hypoxemia in 3 infants and white-out on chest x-ray in 5 cases. None of the patients in the SVL group had these findings. The peak mean airway pressure in the LVL group was higher than that in the SVL group (16.0±2.65 vs 13.3±3.01 cmH2O, P=0.046). Conclusions: SVL has the same benefits in neonatal MAS as LVL. However, SVL appears to be associated with fewer adverse events. |
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