SERÇE Ö, BENZER D, GÜRSOY T, OVALI F, KARATEKİN G

Respiratuar Distres Sendromunun Tedavisinde Proctant Alfa ve Beractant Surfaktının Karşılaştırılması

Amaç: Surfaktan preparatları solunum fonksiyonlarını iyileştirerek respiratuar distres sendromuna bağlı komplikasyon ve ölüm oranlarını azaltmaktadırlar. Bu çalışmada poractant alfa ve beractant surfaktanın çok düşük doğum ağırlıklı yenidoğanlarda hayatın ilk haftasındaki ventilatör ve kan gazı parametreleri ve klinik seyir üzerindeki etkisi retrospektif olarak değerlendirildi. Metod: Yetmiş bir olgudan ilk grubu poractant alfa (Curosurf®) (200 mg/kg); diğer grubu ise beractant (Survanta®) (100 mg/kg) alanlar oluşturdu. İlk dozdan 6 saat sonra FiO2 ≥40 olacak şekilde oksijen desteği gerekenlere ek doz surfaktan (100 mg/kg) uygulandı. Bulgular: Grup 1de (n: 33) 22 yenidoğan bir doz, 9 yenidoğan iki doz, 2 yenidoğan 3 doz surfaktan alırken, Grup 2de (n:38) 24 yenidoğan bir doz, 10 yenidoğan iki doz, 3 yenidoğan üç doz surfaktan almışdı. Grup 1deki yenidoğanlar Grup 2deki yenidoğanlara göre daha düşük tepe inspiratuar basınca ve FiO2ye ihtiyaç göstermişti ve CO2 değerleri daha düşük seyretmişti. Mekanik ventilasyon ve toplam oksijen desteği süresi Grup 1de daha azdı. Grup 1de ölüm yüksek iken (%51-%36), intraventriküler kanama, bronkopulmoner displazi ve hastane yatış süresi daha kısaydı. Ancak tüm bu farklılıklar istatistiksel olarak anlamlı değildi. Sonuçlar: Her iki doğal surfaktan preparatı respiratuar distres sendromu tedavisinde kullanılabilir.

Objective: Various surfactants are used to improve lung function, and to decrease the morbidity and mortality associated with respiratory distress syndrome. We compared the effects of poractant alfa and beractant on gas exchange, ventilator requirements, and outcome in infants with respiratory distress syndrome. Methods: Seventy-one neonates were investigated. Group 1 received proctant alpha (Curosurf®) (200 mg/kg); whereas group 2 received beractant (Survanta®)(100 mg/kg). Neonates who required FiO2 ≥40 after 6 hours received additional doses of surfactant (each of 100 mg/kg). Results: In group 2 (n: 38), 24 neonates received single dose, 10 received two doses, and 3 received three doses. One baby received four doses. In group 1, 22 neonates received one dose, 9 neonates received two doses, and 2 neonates received three doses. Infants in group 1 (n: 33) required a lower peak inspiratory pressure and FiO2, and had lower CO2 levels than infants in group 2. Duration of mechanical ventilation and total oxygen therapy was lower in group 1. The incidences of intraventricular hemorrhage, bronchopulmonary dysplasia, and duration of hospitalization were lower in group 1 despite higher incidence of mortality (51% vs 36%). However, all these differences did not reach statistical significance. Conclusions: Both natural surfactant preparations can be used for the treatment of respiratory distress syndrome.

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