气管内滴入硝普钠治疗新生儿持续肺动脉高压的临床研究

Clinical study on intratracheal instillation of sodium nitroprusside for treating persistent pulmonary hypertension of newborn

目的探讨气管内滴入一氧化氮供体硝普钠对新生儿持续性肺动脉高压(PPHN)的治疗效果和安全性。方法对19例PPHN患儿在机械通气下予以硝普钠气管内滴入,分别于基础状态、气管内滴入硝普钠后30、60、120min测量平均肺动脉压(PAMP)、平均动脉压(AMP)、右上肢及左下肢的经皮血氧饱和度(TcSaO2),并进行比较分析。结果 19例PPHN患儿中,17例患儿原发疾病在肺部,其中82.35%(14/17)的患儿气管内滴入硝普钠后PAMP明显降低,30min时最明显[(21.30±4.20)mm Hg vs.(30.30±4.20)mm Hg)],与治疗前比较差异有统计学意义(P<0.05);但治疗前、后AMP[(56.00±3.00)mm Hg vs.(55.00±6.00)mm Hg]比较,差异无统计学意义(P>0.05)。2例PPHN继发于先天性心脏病者无效。结论气管内滴入硝普钠是治疗PPHN安全、有效且经济的方法。

Objective To investigate the therapeutic effect and safety of the intratracheal instillation of sodium nitroprusside for treating persistent pulmonary hypertension of newborn（PPHN）. Methods The intratracheal instillation of sodium nitroprusside was used to 19 cases of PPHN under the mechanical ventilation,and the pulmonary arterial mean pressure（PAMP）,arterial mean pressure（AMP） ,transcutaneous oxygen saturation（TcSaO~） of the right upper and left lower limb at the basic state, 30,60,120min after intratraeheal instillation of sodium nitroprusside were respectively measured and compared. Results Among 19 cases of PPHN, 17 cases had the primary lung disease. Of 17 cases, 14 cases（82.35 %） had significant decrease of PAMP after intratracheal instillation of sodium nitroprusside, which was most significant at 30min after therapy and the difference was statistically significant compared with before therapy [- （21.30±4. 200） mm Hg vs. （30.30± 4.20） mm Hg, P〈 0.05], but AMP between before and after therapy had no statistical difference[（56.00：1：3.00）mm Hg vs. （55.00±6.00）mm Hg,P〉0.05]. Conelusion The intratracheal instillation of sodium nitroprusside is the safe,effective and economic method for treating PPHN.