高频震荡通气联合米力农治疗新生儿肺源性持续肺动脉高压疗效观察

Clinical Observation of High-Frequency Oscillatory Ventilation Combined with Milrinone in Treatment of Persistent Pulmonary Hypertension in Newborns

目的:探讨高频震荡通气(HFOV)联合米力农治疗新生儿持续肺动脉高压(PPHN)的疗效。方法:将30例肺源性PPHN患儿随机分成三组各10例:(1)CMV+米力农组,应用常频机械通气(CMV)联合米力农治疗;(2)HFOV组,应用HFOV治疗;(3)HFOV+米力农组,应用HFOV联合米力农治疗。米力农用法用量:负荷量50μg/kg,60 min静脉滴注,然后以0.50～0.75μg/(kg.min)维持,连用3 d。监测治疗前后氧合指数(OI)、PaO2/FiO2和血压,比较三组患儿疗效。结果:三组OI、PaO2/FiO2治疗前比较差异无统计学意义(P>0.05),均随着治疗时间的延长而逐渐改善,以HFOV+米力农组改善最为显著,治疗2 h时开始出现明显改善(OI:28.76±5.12→21.06±2.79;PaO2/FiO2:44.74±11.60→57.65±17.53),而另两组改善不明显,在治疗2h、12 h、24 h、36 h时HFOV+米力农组分别与另两组进行两两比较差异均有统计学意义(P<0.05)。三组治疗期间均未出现低血压,治疗后CMV+米力农组、HFOV组、HFOV+米力农组总有效率分别为80.0%、60.0%、90.0%,组间比较差异均有统计学意义(P<0.05)。结论:HFOV联合米力农治疗新生儿肺源性PPHN可有效改善氧合,对血压无明显影响。

[ Abstract] Objective： To explore the effect of high-frequency oscillatory ventilation （HFOV） combined with milrinone in the treatment of persistent pulmonary hypertension （PPHN） caused by pulmonary disease in newborns. Methods： Thirty newborns with PPHN were divided into three groups ： 10 patients were treated conventional mandatory ventilation combined with intravenous milrinone （ CMV ＋ milrinone）, IO patients received high frequency oscillatory ventilation （HFOV） alone, 10 patients received high frequency oscillatory ventilation combined with intravenous milrinone （HFOV＋milrinone） and the milrinone was administrated intravenously load dose 50 μg/kg in 60 minutes, followed by continuous dose of 0.5 ~ 0.75 μg/（ kg min） for three successive days. Oxygenation index （OI）, PaO2/FiO2 and blood pressure were measured before and after the treatment. Results： Before treatment, there was no statistical difference of the OI and PaO=/FiO2 among the three groups. After treatment, the OI and PaO2/FiO2 of the three groups was improved gradually over time. The improvements of OI and PaOJFiO2 were the most obvious in the group who received high frequency oscillatory ventilation combined with intravenous milrinone. After 2 hours of treatment, the OI and PaO2/FiO2 in the HFOV＋ milrinone group started to significantly improved （OI： 28.76±5.12→21.06±2.79; PaO/FiO2 ： 44.74± 11.60→57.65 ±17.53 ）, but the CMV＋milrinone group and the HFOV group did not improved so obviously. After treatment for 2 hours, 12 hours, 24 hours, 36 hours, there was significant difference of the OI and PaO2/FiO2 in the HFOV＋milfinone group compared with the other groups. Hypotension did not occur during treatment. The positive rate of the CMV＋milrinone group ,the HFOV group ,the HFOV＋milrinone group is 80. 0%, 60. 0%, 90. 0%, respectively. Conclusions： The therapy of HFOV combined with milrinone for PPHN improves oxygenation and had no effect on systemic blood pressure.