rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2012-4-95rmt-1389Research ArticleФУНДАМЕНТАЛЬНЫЕ ОСНОВЫ АНЕСТЕЗИОЛОГИИ-РЕАНИМАТОЛОГИИFUNDAMENTALS OF ANESTHESIOLOGY AND REANIMATOLOGYРеспираторный дистресс-синдром новорожденных: ранняя диагностика, профилактика и лечениеNeonatal Respiratory Distress Syndrome: Early Diagnosis, Prevention, and TreatmentПерепелицаС. А.PerepelitsaS. A.sveta_perepeliza@mail.ruГолубевА. М.GolubevA. M.МорозВ. В.MorozV. V.20122606201484Том VIII № 4 2012 г.9595Copyright © Перепелица С.А., Голубев А.М., Мороз В.В., 20122012Перепелица С.А., Голубев А.М., Мороз В.В.Perepelitsa S.A., Golubev A.M., Moroz V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/1389

Цель исследования — улучшение результатов лечения недоношенных новорожденных с РДСН путем выявления механизмов развития, разработки методов ранней диагностики, лечения и профилактики заболевания. Материал и методы. В работе представлен анализ результатов клинического наблюдения, лабораторно-инструментального, иммунологического, морфологического и рентгенологического обследования 320 недоношенных новорожденных с гестационным возрастом 26—35 недель. Выделены следующие группы новорожденных: 1-я группа «Сравнения» — 40 недоношенных новорожденных без клинических проявлений РДСН и физиологическим течением раннего неонатального периода; 2-я группа — 190 недоношенных новорожденных с тяжелым течением РДСН, у которых проводилась сравнительная оценка эффективности терапии экзогенными сурфактантами: сурфактанта БЛ и куросурфа; 3 группа — 90 недоношенных новорожденных, умерших от РДСН на разных стадиях развития заболевания. Результаты. Неблагоприятный соматический и акушерско-гинекологический анамнез матерей с ранних сроков настоящей беременности создает предпосылки ее прерывания, способствует развитию тяжелой формы острого гестоза и вызывает патологические изменения в плаценте. Для каждого гестационного возраста характерны определенные изменения в плаценте, способствующие нарушению маточно-плацентарно-плодового кровотока и наступлению преждевременных родов. Ведущую роль в танатогенезе РДСН играют повреждение альвеолярного и бронхиального эпителия, в том числе анте- и интранатально, расстройства микроциркуляции. Одним из важных факторов, способствующих повреждению альвеолярного эпителия и развитию РДСН у недоношенных новорожденных, является интранатальная гипоксия и аспирация околоплодных вод. Экзогенные сурфактанты препятствуют развитию гиалиновых мембран, способствуют нормализации вентиляционно-перфузионных отношений и биомеханических свойств легких. Заключение. Проведенное исследование позволило улучшить диагностику и лечение РДСН, что способствовало уменьшению продолжительности ИВЛ со 130±7,6 часов до 65,4±11,6 часов, количества осложнений (частота внутрижелудочковых кровоизлияний уменьшилась с 28,8 до 9%), сокращению пребывания новорожденных в отделении реанимации, снижению ранней неонатальной смертности с 9,3 до 0,9‰, улучшению демографических показателей.

to improve treatment results in premature infants with neonatal respiratory distress syndrome (NRDS), by establishing developmental mechanisms and elaborating methods for its early diagnosis, treatment, and prevention. Material and methods. The paper analyzes the results of a clinical observation and laboratory, instrumental, immunological, morphological, and radiological studies of 320 premature neonates at 26—35 weeks gestational age. The following groups of neonates were identified: 1) 40 premature neonatal infants without NRDS and with the physiological course of an early neonatal period (a comparison group); 2) 190 premature neonates with severe NRDS in whom the efficiency of therapy with exogenous surfactants, such as surfactant BL versus curosurf, was evaluated; 3) 90 premature newborn infants who had died from NRDS at its different stages. Results. The poor maternal somatic, obstetric, and gynecological histories in the early periods of the current pregnancy create prerequisites for its termination, favor the development of severe acute gestosis, and cause abnormal placental changes. Each gestational age is marked by certain placental changes that promote impaired uterineplacentalfetal blood flow and premature birth. Alveolar and bronchial epithelial damages, including those ante and intranatally, microcircula tory disorders play a leading role in the tanatogenesis of NRDS. Intranatal hypoxia and amniotic fluid aspiration are one of the important factors contributing to alveolar epithelial damage and NRDS in premature neonates. Exogenous surfactants prevent the development of hyaline membranes and are useful in the normalization of ventilation-perfusion relationships and lung biomechanical properties. Conclusion. This study could improve the diagnosis and treatment of NRDS, which assisted in reducing the duration of mechanical ventilation from 130±7.6 to 65±11.6 hours, the number of complications (the incidence of intragastric hemorrhages decreased from 28.8 to 9%), the stay length of the neonates in an intensive care unit, and early neonatal mortality rates from 9.3 to 0.9‰ and in improving demographic indicators. 

недоношенные новорожденныецитокиныреспираторный дистресс-синдром новорожденныхэкзогенные сурфактантыгиалиновые мембраны.premature neonatescytokinesneonatal respiratory distress syndromeexogenous surfactantshyaline membranesReferencesDementyeva G.M. Low birth weight. Fetal and neonatal hypoxia. Lecture for the physician. Moscow: Moscow Research Institute of Pediatrics and Pediatric Surgery, Ministry of Health of the Russian Federation; 2003. [In Russ.].Dementyeva G.M. Low birth weight. Fetal and neonatal hypoxia. Lecture for the physician. Moscow: Moscow Research Institute of Pediatrics and Pediatric Surgery, Ministry of Health of the Russian Federation; 2003. [In Russ.].Baibarina E.N., Antonov A.G., Lenyushkina A.A. Clinical care guidelines for extremely low birth weight neonatal infants. Voprosy Prakt. Pediatrii. 2006; 4 (1): 96—97. [In Russ.].Baibarina E.N., Antonov A.G., Lenyushkina A.A. Clinical care guidelines for extremely low birth weight neonatal infants. Voprosy Prakt. Pediatrii. 2006; 4 (1): 96—97. [In Russ.].Sidelnikova V.M., Antonov A.G. Premature birth. Premature baby. Moscow: GEOTAR — Media; 2006. [In Russ.].Sidelnikova V.M., Antonov A.G. Premature birth. Premature baby. Moscow: GEOTAR — Media; 2006. [In Russ.].Pestrikova T.Yu., Yurasova E.A., Butko T.M. Perinatal losses. Reduction reserves. Moscow: Littera; 2008. [In Russ.].Pestrikova T.Yu., Yurasova E.A., Butko T.M. Perinatal losses. Reduction reserves. Moscow: Littera; 2008. [In Russ.].Callaghan W. M., MacDorman M. F., Rasmussen S. A., Qin C., Lackritz E. M. The contribution of preterm birth to infant mortality rates in the United States. Pediatrics. 2006; 118 (4): 1566—1573.Callaghan W. M., MacDorman M. F., Rasmussen S. A., Qin C., Lackritz E. M. The contribution of preterm birth to infant mortality rates in the United States. Pediatrics. 2006; 118 (4): 1566—1573.Shapiro-Mendoza C. K., Tomashek K. M., Kotelchuck M., Barfield W., Nannini A., Weiss J., Declercq E. Effect of latepreterm birth and maternal medical conditions on newborn morbidity risk. Pediatrics. 2008; 121 (2): e223—e232.Shapiro-Mendoza C. K., Tomashek K. M., Kotelchuck M., Barfield W., Nannini A., Weiss J., Declercq E. Effect of latepreterm birth and maternal medical conditions on newborn morbidity risk. Pediatrics. 2008; 121 (2): e223—e232.Sukhanova L.P. Causes of perinatal mortality in Russia. Proceedings of the 5th Congress of the Russian Association of Perinatal Medicine Specialists on Current Approaches to Detection, Treatment, and Prevention of Perinatal Pathology. Moscow. 2005. 194—196. [In Russ.].Sukhanova L.P. Causes of perinatal mortality in Russia. Proceedings of the 5th Congress of the Russian Association of Perinatal Medicine Specialists on Current Approaches to Detection, Treatment, and Prevention of Perinatal Pathology. Moscow. 2005. 194—196. [In Russ.].Chumakova O.V., Baibarina E.N., Tsymlyakova L.M., Antonov A.G., Frolova O.G., Sorokina Z.Kh. Nursing of extremely low birth weight infants: Organizational aspects. Ross. Vestn. Perinatol. i Pediatrii. 2008; 53 (5): 49. [In Russ.].Chumakova O.V., Baibarina E.N., Tsymlyakova L.M., Antonov A.G., Frolova O.G., Sorokina Z.Kh. Nursing of extremely low birth weight infants: Organizational aspects. Ross. Vestn. Perinatol. i Pediatrii. 2008; 53 (5): 49. [In Russ.].Geppe N.A., Volkov I.K. Pediatric Pulmonology in Russia: Developmental prospects and problems. Pulmonologiya. 2007; 4: 6. [In Russ.].Geppe N.A., Volkov I.K. Pediatric Pulmonology in Russia: Developmental prospects and problems. Pulmonologiya. 2007; 4: 6. [In Russ.].Bramley D.W., Blackman L.R. Critical conditions in infants. Moscow: Meditsina Publishers; 1980. [In Russ.].Bramley D.W., Blackman L.R. Critical conditions in infants. Moscow: Meditsina Publishers; 1980. [In Russ.].Sotnikova K.A. The state of the art of neonatal respiratory distress syndrome. Neonatal respiratory distress syndrome. Moscow: Meditsina Publishers; 1980. [In Russ.].Sotnikova K.A. The state of the art of neonatal respiratory distress syndrome. Neonatal respiratory distress syndrome. Moscow: Meditsina Publishers; 1980. [In Russ.].Emmanouilidis G.K., Baylen B.G. Neonatal cardiopulmonary distress. Moscow: Meditsina Publishers, 1994. [In Russ.].Emmanouilidis G.K., Baylen B.G. Neonatal cardiopulmonary distress. Moscow: Meditsina Publishers, 1994. [In Russ.].Grebennikov V.A., Milenin O.B., Ryumina I.I. Results of clinical trials of Exosurf Neonatal, a synthetic surfactant, in Russia. Pediatriya. 1995; 3: 65—68. [In Russ.].Grebennikov V.A., Milenin O.B., Ryumina I.I. Results of clinical trials of Exosurf Neonatal, a synthetic surfactant, in Russia. Pediatriya. 1995; 3: 65—68. [In Russ.].Golubev A.M., Perepelitsa S.A., Smerdova E.F., Moroz V.V. Clinical and morphological features of respiratory disorders in premature neonates. Obshchaya Reanimatologiya. 2008; 4 (3): 49—55. [In Russ.].Golubev A.M., Perepelitsa S.A., Smerdova E.F., Moroz V.V. Clinical and morphological features of respiratory disorders in premature neonates. Obshchaya Reanimatologiya. 2008; 4 (3): 49—55. [In Russ.].Perepelitsa S.A., Golubev A.M., Moroz V.V. Choice of ventilation mode for preterm neonatal infants with respiratory distress syndrome. Obshchaya Reanimatologiya. 2010; 6 (3): 67—70. [In Russ.].Perepelitsa S.A., Golubev A.M., Moroz V.V. Choice of ventilation mode for preterm neonatal infants with respiratory distress syndrome. Obshchaya Reanimatologiya. 2010; 6 (3): 67—70. [In Russ.].Avery M. E., Mead J. Surface properties in relation to atelectasis and hyaline membrane disease. AMA J. Dis. Child. 1959; 97 (5 Part 1): 517—523.Avery M. E., Mead J. Surface properties in relation to atelectasis and hyaline membrane disease. AMA J. Dis. Child. 1959; 97 (5 Part 1): 517—523.Gitlin D., Craig J. M. The nature of hyaline membrane in asphyxia of the newborn. Pediatrics. 1956; 17 (1): 64—71.Gitlin D., Craig J. M. The nature of hyaline membrane in asphyxia of the newborn. Pediatrics. 1956; 17 (1): 64—71.Golubev A. M., Perepelitsa C. A., Moroz V. V. Morphological characteristics of newborns` lungs with hyaline membranes disease in surfactants use. Novinky v anesteziologii a intenzivnej medicine. Zbornik vycha ́dza pri prilezitosti 16. medzina ́rodne ́ho kongresu Slovenskej spolocnosti aneste ́ziolo ́gie a intenzivnej mediciny konanom v Piešt'anoch 20—22 ma ́ja 2009. Piešt`any. 26—27.Golubev A. M., Perepelitsa C. A., Moroz V. V. Morphological characteristics of newborns` lungs with hyaline membranes disease in surfactants use. Novinky v anesteziologii a intenzivnej medicine. Zbornik vycha ́dza pri prilezitosti 16. medzina ́rodne ́ho kongresu Slovenskej spolocnosti aneste ́ziolo ́gie a intenzivnej mediciny konanom v Piešt'anoch 20—22 ma ́ja 2009. Piešt`any. 26—27.Obladen M. Neugeborenenintensivpflege. Berlin — Heidelberg: Springer-Verlag; 2002.Obladen M. Neugeborenenintensivpflege. Berlin — Heidelberg: Springer-Verlag; 2002.Wauer R. R. Respiratory Distress Syndrome. In: Wauer R. R. (ed.). Surfactant therapy: basic principles, diagnosis, therapy. Stuttgart — New York: Thieme; 1998.Wauer R. R. Respiratory Distress Syndrome. In: Wauer R. R. (ed.). Surfactant therapy: basic principles, diagnosis, therapy. Stuttgart — New York: Thieme; 1998.Greenough A., Dimitriou G., Prendergast M., Milner A. D. Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database Syst. Rev. 2008; 1: CD000456.Greenough A., Dimitriou G., Prendergast M., Milner A. D. Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database Syst. Rev. 2008; 1: CD000456.Soll R. F., Morley C. J. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst. Rev. 2000; 2: CD000510.Soll R. F., Morley C. J. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst. Rev. 2000; 2: CD000510.Rozenberg O.A., Seiliyev A.A. Natural lung surfactants for the treatment of respiratory distress syndrome in the newborns and adults. Proceedings of the 2nd International Congress on Topical Problems in the Design of New Natural Drugs. Saint Petersburg; 1998. 81—85. [In Russ.].Rozenberg O.A., Seiliyev A.A. Natural lung surfactants for the treatment of respiratory distress syndrome in the newborns and adults. Proceedings of the 2nd International Congress on Topical Problems in the Design of New Natural Drugs. Saint Petersburg; 1998. 81—85. [In Russ.].Rozenberg O.A., Osovskikh V.V., Granov D.A. Surfactant therapy for respiratory failure in critical conditions and other diseases of the lung. Saint Petersburg; 2002. [In Russ.].Rozenberg O.A., Osovskikh V.V., Granov D.A. Surfactant therapy for respiratory failure in critical conditions and other diseases of the lung. Saint Petersburg; 2002. [In Russ.].Hall R.T. Indications for surfactant therapy — the aAPO2 coming of age. Pediatrics. 1999; 103 (2): E25. [In Russ.].Hall R.T. Indications for surfactant therapy — the aAPO2 coming of age. Pediatrics. 1999; 103 (2): E25. [In Russ.].Jobe A.H. Mechanisms to explain surfactant response. Biol. Neonate. 2006; 89 (4): 298—302. [In Russ.].Jobe A.H. Mechanisms to explain surfactant response. Biol. Neonate. 2006; 89 (4): 298—302. [In Russ.].Perepelitsa S.A., Golubev A.M., Moroz V.V. Effect of exogenous surfactants on blood gas composition parameters in neonatal infants with respiratory distress syndrome. Obshchaya Reanimatologiya. 2007; 3 (3): 59—64. [In Russ.].Perepelitsa S.A., Golubev A.M., Moroz V.V. Effect of exogenous surfactants on blood gas composition parameters in neonatal infants with respiratory distress syndrome. Obshchaya Reanimatologiya. 2007; 3 (3): 59—64. [In Russ.].Perepelitsa S.A., Golubev A.M., Moroz V.V. The specific features of artificial ventilation in premature neonates with respiratory distress syndrome. Obshchaya Reanimatologiya. 2010; 6 (1): 11—16. [In Russ.].Perepelitsa S.A., Golubev A.M., Moroz V.V. The specific features of artificial ventilation in premature neonates with respiratory distress syndrome. Obshchaya Reanimatologiya. 2010; 6 (1): 11—16. [In Russ.].Peretyatko L.P., Kulida L.V., Protsenko E.V. Morphology of fetuses and extremely low birth weight neonates. Ivanovo; 2005. [In Russ.].Peretyatko L.P., Kulida L.V., Protsenko E.V. Morphology of fetuses and extremely low birth weight neonates. Ivanovo; 2005. [In Russ.].Burri P. H. Morphology and respiratory function of the alveolar unit. Int. Arch. Allergy Appl. Immunol. 1985; 76 (Suppl 1): 2—12.Burri P. H. Morphology and respiratory function of the alveolar unit. Int. Arch. Allergy Appl. Immunol. 1985; 76 (Suppl 1): 2—12.

The authors declare that there are no conflicts of interest present.