Solunum Sıkıntısı Sendromunda Daha Az İnvazif Sürfaktan Verme Tekniklerinin Karşılaştırılması

Abstract

Giriş: Bu çalışmada; RDS’li bebeklerde yeni geliştirilen ve daha az invaziv surfaktan uygulama yöntemlerinin (ince kateter yöntemi ve INSURE) etkinliğini değerlendirmesi ve bu yöntemlerin birbiriyle karşılaştırılması amaçlandı.

Gereç ve Yöntem: Spontan soluyan ve surfaktan ihtiyacı olan 685-2100 gr arasında 15 hasta çalışmaya alındı. Hastaların 7’sine ince kateter yöntemi, 8’ine ise INSURE yöntemi ile surfaktan uygulandı.

Bulgular: Hastaların doğum şekli, kilo, cinsiyeti, prenatal öyküleri, steroid kullanımları, APGAR skorları ve hasta taburcu edilinceye kadar tüm veriler kaydedildi. Minimal invaziv sürfaktan tedavisi uygulanan grupta %71 (5/7), INSURE uygulanan grupta %87,5 (7/8) 3-4 dakika süren desaturasyon ve bradikardi gözlendi. INSURE grubunda 8 hastanın 4’ ünde bradikardi gözlendi ve pozitif basınçlı ventilasyona ihtiyaç duyuldu. Entübasyon-Sürfaktan-Ekstübasyon grubundan 3 hasta hayatını kaybetti; 15 hastanın birinde, ROP gelişti ve bu hasta da INSURE uygulanan gruptaydı. Gruplar arasında, MV’de kalış süresi ve mortalitede istatistiksel açıdan anlamlı idi (p<0.01). Hastanede kalış süresi ve O2 ihtiyaç süreleri arasında farklılığın olmadığı belirlendi
(P<0.05). İnce kateter yönteminde mekanik ventilatörde kalış süresi vemortalite oranları daha düşük olarak belirlendi (p<0.05).

Sonuç: Spontan soluyan ve surfaktan ihtiyacı olan prematüre bebekler surfaktan tedavisi için entübe edilmesine gerek yoktur. Uygulanan her iki yöntem surfaktan verilişi açısından uygundur. Bu çalışmada entübe edilmeden surfaktan uygulama metotları içerisinde, hasta sonuçları açısından en uygun ve başarılı metotun ince kateter yöntemi olduğu sonucuna varıldı.

Keywords

• Respiratuar Distres Sendromu
• surfaktan
• komplikasyon
• veriliş yöntemi
• CPAP

Comparison Of Less Invasive Surfactant Delivery Techniques In Respiratory Distress Syndrome

Abstract

Background: This study was conducted to evaluate and compare the effectiveness of newly developed minimal invasive methods for surfactant administration (LISA by using Magill forceps, INSURE) Methods: The research was conducted on 15 patients between 685-2100 gr weight, requiring surfactant administration. Poractant alpha, dose 200 mg/kg, was administered to patients with spontaneous breathing on continuous positive airway pressure support. LISA was used to administer surfactant to 7 of 15 patients, whereas 8 of them had surfactant administered using the INSURE method. Results: The data regarding the delivery method, birth weight, gender, prenatal history, usage of steroids, APGAR scores and other data about the patients until hospital discharge were recorded. Desaturation and bradycardia for 3-4 minutes were observed in 71% (5/7) of LISA and 87.5% (7/8) of INSURE cases. Bradycardia was observed in 4 of 8 patients from the INSURE group and positive ventilation was needed. From the INSURE group, 3 patients died; one of 15 had ROP and this patient was from the INSURE group. No difference was found among the groups regarding required duration of O2 and days of hospital stay (p<0.05). The thin catheter group had significantly fewer median days on mechanical ventilation and lower rate of mortality (p<0.05). Conclusions: When there is no need for mechanical ventilation, intubation for surfactant administration was determined not to be necessary in the present study. LISA was observed to be the best method for surfactant administration among the methods without intubation.

Keywords

• Respiratory distress syndrome
• surfactant
• complications
• new method

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