Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Effect of surfactant lavage in severe meconium aspiration syndrome

중증 태변 흡인 증후군에서 인공 폐표면활성제 세정요법의 효과에 관한 비교 연구

  • Lee, Soon Min (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Kim, He Min (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Jeon, Ji Hyun (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Park, Min Soo (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Park, Kook In (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Namgung, Ran (Department of Pediatrics, Yonsei University College of Medicine) ;
  • Lee, Chul (Department of Pediatrics, Yonsei University College of Medicine)
  • 이순민 (연세대학교 의과대학 소아과학교실) ;
  • 김혜민 (연세대학교 의과대학 소아과학교실) ;
  • 전지현 (연세대학교 의과대학 소아과학교실) ;
  • 박민수 (연세대학교 의과대학 소아과학교실) ;
  • 박국인 (연세대학교 의과대학 소아과학교실) ;
  • 남궁란 (연세대학교 의과대학 소아과학교실) ;
  • 이철 (연세대학교 의과대학 소아과학교실)
  • Received : 2007.10.01
  • Accepted : 2007.11.30
  • Published : 2008.04.15
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Abstract

Purpose : The surfactant dysfunction may play an important role in meconium aspiration syndrome (MAS). We aim to evaluate the effect of surfactant lavage in the treatment of term infants with MAS. Methods : The medical records of 15 neonates with severe MAS admitted at Yongdong Severance Hospital from 2005 to 2007 were reviewed and analyzed. Seven infants with severe MAS necessitating mechanical ventilation underwent tracheobronchial lavage with 20 mL/kg of diluted (5.3 mg phospholipid/mL) surfactant saline suspension ($Newfactan^{(R)}$). Data regarding clinical outcomes was assessed by comparison with 8 control infants with equally severe MAS retrospectively. Results : In the lavage group, radiological improvement was evident after 6 hours of treatment. The duration of artificial ventilation and duration of hospital day were also significantly shorten in the lavage group compared with the control group. The mean oxygen index, mean ventilation index improved significantly within the first 6 hours after treatment. No differences were found in the incidence of major complications and mortality between the two groups. Conclusion : The surfactant lavage seems to be an effective and safe method for treatment of severe MAS. A multicenter, large scaled randomized controlled trial is needed for further study.

목 적 : 폐표면활성제의 비활성화는 태변 흡인 증후군의 중요한 기전으로 알려져 있다. 저자들은 중증 태변 흡인 증후군에서 인공 폐표면활성제 세정요법의 효과를 연구하고자 하였다. 방 법 : 2005년 3월부터 2007년 8월까지 연세대학교 의과대학 영동세브란스병원 신생아 중환자실에 중증 태변 흡인 증후군으로 입원한 만삭아 15명 중 본 기관에서 인공 폐표면활성제 세정요법을 시행한 이후인 2006년 12월부터 2007년 8월까지 입원하여 태변 흡인 증후군을 진단 받고 oxygen index가 15 이상 혹은 평균 기도압이 $12cmH_2O$ 이상인 환아 7명을 대상으로 20 mL/kg 의 희석 된 인공 폐표면활성제($Newfactan^{(R)}$)로 세정요법을 시행하였다. 동일한 선별기준에 따라 2005년 3월부터 2006년 11월까지 입원하여 보존적 치료를 시행한 환아를 후향적으로 조사하여 8명의 대조군으로 정하였다. 결 과 : 세정요법 군은 특이 이상 반응 없이 안전하게 세정요법을 시행받았으며, 치료 6시간 후부터 방사선학적인 호전을 보였다. 세정요법 시행 6시간 후 oxygen index, ventilation index는 대조군에 비해 유의하게 감소하였으며, 평균 호흡기 사용시간, 평균 재원기간에 있어 대조군에 비해 유의한 감소를 보였다. 두 군간에 합병증이나 치사율에 차이는 보이지 않았다. 결 론 : 본 연구에서 희석된 폐표면활성제로 세정요법을 시행한 환아들이 조기에 산소화가 향상되고 기계환기의 기간을 줄일 수 있음이 확인되어 중증 태변 흡인 증후군의 치료로서 폐 표면활성제 세정 요법은 안전하고 효과적으로 독성물질을 제거할 수 있으며 폐표면활성제가 작용할 수 있는 방법으로 여겨진다. 향후 대규모의 다기관 임상연구가 필요하리라 생각된다.

Keywords

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