一氧化氮吸入治疗新生儿呼吸窘迫综合征临床观察

Curative effect of nitric oxide inhalation for the newborns with neonatal respiratory distress syndrome

目的 观察一氧化氮（NO）吸入对新生儿呼吸窘迫综合征（NRDS）治疗作用及其有关影响因素。方法将49例NRDS患儿随机分为两组，对照组24例，采用综合治疗、肺表面活性物质（PS）替代疗法及氧疗等常规治疗；吸入NO（iNO）组25例，在常规治疗基础上加用NO吸入治疗，NO与机械通气同步使用，吸入浓度从10ppm开始，最高不超过30ppm，持续吸入时间24-36h，同时动态观察血气主要指标的变化。结果 治疗后（24h）pH、PaO2、PaCO2、PaO2／FiO2、SaO2及肺泡动静脉氧分压差（A-a）PO2 6项血气指标的改善，iNO组优于对照组（P〈0．01或0．05）；iNO组在治疗后不同时期（1、12、24及36h）6项血气指标均有较好改善，与治疗前相比，除治疗后1h差异无统计学意义（P〉0．05）外，治疗后12、24及36h各项指标差异均有统计学意义（P〈0．05或0．01），且血气指标改善情况与吸入时间相关；iNO组在治愈率、死亡率及并发症发生率等转归方面均优于对照组（均P〈0．05）。结论吸入NO治疗NRDS，尤其是重症和早产患儿，能够显著改善氧合功能，增加通气／血流比值，从而明显缓解临床症状，改善患儿的预后。对吸入NO的最有效时间，尚需进一步研究。

Objective To study the efficacy of nitric oxide （NO） inhalation and influencing factors in the newborns with neonatal respiratory distress syndrome （ NRDS ）. Methods 49 infants with NRDS were randomly divided into two groups： the control group （24 cases） and the NO inhalation（iNO） group （25 cases）. The conventional therapy including complex treatment, pulmonary surfactant （PS） replacement therapy and oxygen therapy were adopted to treat the control group ; on the basis of the conventional therapy, nitric oxide inhalation was joined to treat the iNO group. Nitric oxide inhalation and mechanical ventilation were used simultaneously, the NO concentration ranged from 10 ppm to 30 ppm for 24 - 36 h. In the meantime, the main blood gas indicators were dynamically observed. Results After the treatment （24 h）, the six indicators including pH, PaO2, PaCO2, PaO2/FiO2, SaO2 and （ A - a） PO2 were improved. Curative effect was better in the iNO group than in the control group （ P 〈 0.01 or P 〈 0.05） ; For the iNO group, all the six blood gas indicators were improved at the different times （ 1, 12, 24, 36 h）. There were statistical significances in all the six blood gas indicators at 12, 24, 36 h after nitric oxide inhalation, expect at 1 h, compared with pretherapy（ P 〈0.01 or P 〈0.05 ）, and the improvements correlated with the time of nitric oxide inhalation. The iNO group was superior to the control group in the cure rates, mortality and complications rates （ P 〈 0.05 ）. Conclusions Application of nitric oxide inhalation could cure NRDS more effectively, especially for the pediatric intensive and premature infants, improve systemic oxygenation, increase ventilation/perfusion ratio, and improve the prognosis. More researches are needed to explore the optimum time of nitric oxide inhalation.