The Effect of Bronchial Lavage and Surfactant Supplement on Severe Meconium Aspiration Syndrome

以氣管內沖洗及補充肺表面張力素（Surfactant）治療重症胎便吸入症候群

蘇百弘(Bai-Horng Su) ； 胡博翔(Paul-Shiang Hu) ； 彭慶添(Ching-Tien Peng) ； 蔡長海(Chang-Hai Tsai)

《Mid-Taiwan Journal of Medicine》 3卷4期 (1998/12) Pp. 191-197

https://doi.org/10.6558/MTJM.1998.3(4).1

摘要

胎便吸入症候群是由於氣管內吸入大量的胎便污染羊水引起的新生兒呼吸疾病。胎便會引起氣道阻塞造成肺部充氣不均勻及部份塌陷。以生理食鹽水做氣管沖洗可以除去吸入的胎便，但也會因而造成呼吸狀態惡化。我們認為以積極的氣管內沖洗隨即補充肺表面張力素（surfactant），則可以除去胎便同時避免呼吸狀態之惡化。本研究以10位重症胎便吸入症候群的新生兒為研究對象。納入研究的基準為：在吸入100%氧氣時，肺胞動脈氧分壓差（AaDO_2）＞400，及氧氣指數（OI）＞20。每次使用10 ml/kg的溫生理食鹽水來做氣管沖洗，這個步驟可以重複施行直到氣管內抽出來的水不再有胎便染色。隨即補充肺表面張力素4 ml/kg。所有的病兒經過這種處置後，在胸部X光上及血氧濃度都有很大的改善。我們也報告一個嚴重的病兒，符合施行體外膜型人工肺（ECMO）的基準，經使用一氧化氮吸入療法無效後，改以氣管沖洗加上補充肺表面張力素後得以存活。本研究顯示，積極的氣管沖洗隨即補充肺表面張力素，可以有效的除去吸入的胎便，避免發生重症胎便吸入症候群及其併發症，同時補充相對小量的肺表面張力素來改善呼吸狀態，可以減少ECMO的需要。我們建議在臨床上廣泛使用這種治療之前，應做進一步的對照研究。

關鍵字

胎便吸入症候群 ； 氣管沖洗 ； 肺表面張力素

並列摘要

Meconium aspiration syndrome (MAS) is a neonatal respiratory disorder caused by massive aspiration of meconium-stained amniotic fluid into airways. Meconium induces mechanical obstruction of airways and is characteristic of air trapping and atelectasis. Bronchial lavage with normal saline can remove the aspirated meconium, but respiratory status often deteriorates after this procedure. Aggressive bronchial lavage followed by surfactant supplement may remove aspirated meconium and prevent the deterioration brought on by lavage. Ten infants with severe MAS were included in this study. Inclusion criteria were alveolar-arterial O_2 gradient (AaDO_2) ＞400 mmHg with FiO_2 100% and oxygen index (OI) ＞20. Aggressive bronchial lavage was performed with warm normal saline, 10 ml/kg, administered intratracheally. The procedure was repeated until the bronchial aspiration became non-meconium stained. Beractant (Survanta), 4 ml/kg, was administered immediately after lavage. The chest X-ray findings and oxygenation status improved dramatically after the procedure. The mean AaDO_2 was 510±74 mmHg before bronchial lavage, and decreased to 398±52, 436±56, and 263±157 mmHg at 1 hour, 6 hours and 12 hours after the procedure, respectively. The mean OI was 24.7±7.3 before bronchial lavage, and decreased to 18.5±6.2, 20.6±4.5, and 11.0±7.4 at 1 hour, 6 hours and 12 hours after the procedure, respectively. There were significant differences between the mean values before the procedure and at 1 hour (ρ＜0.05) and between the mean values at 1 hour and 12 hours (ρ＜0.05) for AaDO_2 and OI. We also report an infant who met the criteria for extracorporeal membrane oxygenation (ECMO), with failed inhaled nitric oxide (iNO) treatment, but with successful lavage treatment. We conclude that aggressive bronchial lavage followed by surfactant supplement should be considered as an effective treatment for severe MAS. In addition, this procedure may decrease the need for ECMO. However, further randomized controlled trials are indicated before implementing widespread clinical use of this treatment strategy to treat severe MAS.

並列關鍵字

meconium aspiration syndrome (MAS) ； bronchial lavage ； surfactant