吸入一氧化氮技术治疗新生儿严重低氧血症的疗效分析

The effects of inhaled nitrogen oxide in severe hypoxemia of neonates

目的:探讨吸入一氧化氮(iNO)治疗新生儿严重低氧血症的临床疗效。方法:38例重症呼吸衰竭新生儿,平均胎龄(34±6)周,体重(2 187±181)g,因在常频通气(CMV)治疗过程中出现F iO2≥0.8,平均气道压≥0.98 kPa,持续2 h以上经皮氧饱和度≤90%或氧合指数(O I)>40而采用iNO,治疗过程中监测心率、血压、动脉血气、动脉肺泡氧分压(a/A)、及氧合指数等。结果:38例患儿用iNO后2 h经皮血氧饱和度(SPaO2)均≥90%;在实施iNO治疗24 h后,动脉肺泡氧分压(a/A PaO2kPa)由0.09±0.03升至0.26±0.12,氧合指数(O I)由33±12降至9±4;所需氧浓度(F iO2%)亦由79.78±19.81,显著降至55.31±19.35。结论:iNO治疗新生儿严重低氧血症可获得显著疗效,用CMV无效后可给予iNO。

Objective： To investigate the effects of inhaled nitrogen oxide（iNO） in the neonates with severe hypoxemia.Methods： 38 newborn infants in severe hypoxemia with gestational age of 34±6 weeks,birth weight（2 187 ±181） g,were enrolled in the study.The infants were given iNO with FiO_2≥0.8,MAP≥10 cm H_2O,SPaO_2 ≤90 % lasted for more than 2 hours during the conventional mechanical ventilation（CMV） or oxygenation indexes OI40.The heart rate,arterial blood gas analysis,arterial to alveoli oxygen ratio（a/ A） and the oxygenation index were monitored during iNO.Results： After 2 hours treatment with iNO,SPaO_2 increased to 90%,24 hours later,the arterial to alveoli oxygen ratio（a/ A PaO_2 kPa） increased from 0.09±0.03 to 0.26±0.12,the oxygenation index（OI） deceased from 33±12 to 9±4,and FiO_2（%） deceased rapidly from 79.78±19.81 to 55.31±19.35.Conclusion： iNO was an effective method for neonatal infants with severe res hypoxemia.