NO治疗新生儿持续肺动脉高压

Nitric Oxide Therapy in Persistent Pulmonary Hypertension of Newborn

目的:探讨吸入一氧化氮(iNO)联合高频振荡通气(HFOV)治疗新生儿持续性肺动脉高压(PPHN)的有效性和安全性。方法:选取PPHN患儿36例,其中无器质性心脏病30例(Ⅰ组),有先天性心脏病6例(Ⅱ组);对所有患儿进行HFOV和iNO联合治疗。监测NO吸入前、吸入30min及24h后的氧合指数(OI)、平均压、肺动脉压力(SPAP)、心率、平均气道压(MAP)、动脉导管前后的经皮血氧饱和度(TcSaO2),吸入NO30min及24h后测定高铁血红蛋白(MetHb)与NO2浓度。结果:Ⅰ组,与吸入前比较,吸入30min和24h后,MAP、OI和SPAP均下降,导管前TcSaO2和导管后TcSaO2升高,心率在吸入24h后下降,差异有统计学意义(P<0.01)。Ⅱ组,吸入前后所有的检测指标差异均无统计学意义(P>0.05)。治愈26例,死亡4例,放弃治疗6例。本组治疗期间,MetHb和NO2浓度均在正常范围。结论:肺血管痉挛型PPHN患儿应尽早采用最低有效剂量iNO联合HFOV治疗。特别是≥34周早产PPHN患儿疗效更佳。

Objective：To study the therapeutic effects and safety of inhaled nitric oxide （iNO） and high-frequency oscillatory ventilation in neonatal .persistent pulmonary hypertension （PPHN）, Methods：Thirty-six neonates with PPHN were selected in this study including 30 without structural heart disease （group I ） and 6 with congenital heart disease （group II ）. The combined treatment of HFPV and iNO was used in all neonates. The values of oxygenation index （OI）, mean blood pressure, systolic pulmonary artery pressure （SPAP）, heart rate, mean airway pressure （MAP） and saturation of blood oxygen per cutem （TcSaO2） were detected before NO inhalation, after 30 min of NO inhalation and 24 h after inhalation. The values of methaemoglobin （MetHb） and nitrogen dioxide （NO：） concentration were monitored 30 rain and 24 h after NO inhalation. Results： In group I, levels of MAP, OI and SPAP decreased significantly 30 rain and 24 h after inhalation. The level of TcSaO2 was increased significantly, and heart rate was decreased significantly 24 h after inhalation （P 〈 0.01）. In group II, there were no significant changes before and after NO inhalation （P 〉 0.05）. In this study, 26 neonates survived, 4 neonates died and 6 neonates gave up treatment. The levels of MHb and NO2 were normal during the treatment. Conclusion： Inhaling minimum effective dosage NO as soon as possible was beneficial in PPHN with pulmonary angiospam, which showed a especially better effect for premature infants （≥34 W）.