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재태주령 30주 미만 미숙아에서 예방적 인공 폐 표면 활성제 투 여와 비강 양압 환기 적용

Prophylactic Administration of Surfactant with Nasal Continuous Positive Airway Pressure in Preterm Infants with Gestational Age Less than 30 Weeks

신연심|장영표|성인창
대한신생아학회 (THE KOREAN SOCIETY OF NEONATOLOGY)|2012.11|Neonatal medicine|제19권 제4호|pp. 253-261

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SurfactantPreterm infantRespiratory distress syndromeMechanical ventilationnCPAP

초록

목적: 극소 미숙아에서 예방적 인공 폐 표면 활성제 투여와 비강양압 환기를 적용하는 방법의 치료 효과와 안전성을 조사하고자 하였다. 방법: 재태주령 24-29주 미숙아 33명을 대상으로 출생 후 15분 이내에 호흡 곤란 치료를 위해 예방적 인공 폐 표면 활성제를 투여하고빠른 기관지 관 제거 후 비강 양압 환기 적용 방법으로 치료를 시행하였다. 산소 치료와 기계적 환기 치료와 관련된 변수와 합병증을 과거에 호흡 곤란 증후군으로 구조적 인공 폐 표면 활성제 투여와 지속적 기계적 환기 방법으로 치료 받았던 상응하는 재태주령의 24명의미숙아와 비교하였다. 결과: 예방적 인공 폐 표면 활성제 투여에 이은 비강 양압 환기 치료는 구조적 인공 폐 표면 활성제 투여에 이은 지속적 기계적 환기치료와 비교하여 총 산소 치료 기간과 총 기계적 환기 치료 기간을줄여주지 않았다(각각 P=0.622, P=0.122). 교정연령 36주에 사망과기관지폐 형성 이상, 산소 치료 또는 기계적 환기와 연관된 합병증들의 빈도는 대상 환아군의 낮은 재태주령과 출생 체중에도 불구하고증가하지 않았다. 재태주령 27-29주를 가진 환아를 대상으로 한 하위 집단 분석에서 총 기계적 환기 치료 기간이 예방적 인공 폐 표면활성제 투여에 이은 비강 양압 환기 치료를 받은 대상아에서 감소하는 경향을 보였다(odd ratio, 0.93, 95% confidence interval, 0.87,1.00, P=0.051). 결론: 호흡 곤란 치료를 위한 예방적 인공 폐 표면 활성제 투여에이은 비강 양압 환기 치료는 구조적 인공 폐 표면 활성제 투여에 이은 지속적 기계적 환기 치료와 비교하여 재태주령 27-29주 환아에서 기계적 환기 치료 기간을 줄여 주는 경향이 보였다.

Abstract

Purpose: This study was performed to investigate the effectiveness and safety of the prophylactic administration method of surfactant,followed by rapid extubation to nasal CPAP (nCPAP) in very preterm infants. Methods: Thirty-three preterm infants with 24-29 weeks gestational age (GA) were treated with the method of prophylactic administration of surfactant by a brief intubation within 15 minutes after birth and rapid extubation to nCPAP for the treatment of respiratory distress. The variables and complications related to oxygen therapy and mechanical ventilation (MV) were compared with those of 24 historical control infants with comparable GA, treated with the rescue surfactant administration with prolonged MV for the respiratory distress syndrome (RDS). Results: Prophylactic surfactant with nCPAP did not reduce the total durations of oxygen therapy and MV, compared with the rescue surfactant with MV (P=0.622 P=122, respectively). The incidence of death and BPD at 36 weeks postmenstrual age (PMA)and other complications related to oxygen therapy and MV were not increased in the infants treated with prophylactic surfactant with nCPAP despite the lower GA and birth weight. In the subgroup analysis for infants with 27-29 weeks of GA, the total duration of MV tended to decrease in infants treated with prophylactic surfactant with nCPAP (Odd ratio, 0.93, 95% Confidence interval, 0.87,1.00, P=0.051). Conclusion: Prophylactic surfactant administration followed by rapid extubation to nCPAP tended to reduce the duration of MV in infants with GA of 27-29 weeks, compared with the rescue surfactant administration with prolonged MV for RDS.

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