外源表面活性剂 (活性剂) 对儿科急性肺损伤的影响:一项随机对照试验
Douglas F Willson1, Neal J Thomas, Barry P Markovitz
1Department of Pediatrics, University of Virginia Health System, Children's Medical Center, Charlottesville, VA 22908, USA. dfw4m@virginia.edu
JAMA
|January 27, 2005
概括
卡尔法克坦改善了小儿急性肺损伤 (ALI) 患者的氧化和降低了死亡率,但没有缩短呼吸衰竭的持续时间. 这项研究为年轻患者的ALI治疗提供了希望.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 肺部病理学 肺部病理学
- 新生儿科学 新生儿科学
背景情况:
- 儿童急性肺损伤 (ALI) 与表面活性剂功能障碍有关.
- 之前对成人ALI进行表面活性剂治疗的试验没有成功.
- 初步研究表明,天然肺表面活性剂 (calfactant) 可能有利于儿科ALI.
研究的目的:
- 评估在患有ALI的婴儿,儿童和青少年中内内起作用剂灌注的疗效.
- 为了确定 calfactant 治疗是否缩短了儿科 ALI 患者呼吸衰竭的持续时间.
主要方法:
- 一个多中心的,随机的,盲目的试验比较calfactant与安慰剂在153名儿科ALI患者.
- 患者接受了两个剂量活性剂或空气安慰剂,间隔12小时.
- 关键结局包括无呼吸器日和死亡率;次要结局评估了医院病程和机械通风反应.
主要成果:
- 原剂在急性施用后显著改善了氧化 (P = .01).
- 与安慰剂相比,calfactant组的死亡率明显较低 (OR,2.32;95% CI,1.15-4.85).与安慰剂相比,calfactant组的死亡率明显较低 (OR, 2.32;95% CI,1.15-4.85).
- 没有观察到无呼吸器日,重症监护室住宿或住院时间的显著差异.
结论:
- 卡尔法克坦在氧化方面表现出急性益处,并降低了儿科ALI的死亡率.
- 在这个儿科患者群体中,calfactant并没有显著缩短呼吸衰竭的过程.
- 进一步的研究可能会探索最佳剂量或患者选择用于ALI中calfactant治疗的最佳剂量.
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