一氧化氮吸入治疗新生儿肺动脉高压疗效的初步评价

NITRIC OXIDE INHALATION FOR NEONATAL PULMONARY HYPERTENSION

利用彩色多普勒超声心动图技术 ,评价一氧化氮 (NO)吸入治疗新生儿肺动脉高压的疗效。对 8例新生儿因肺炎、肺透明膜病、持续胎儿循环和先天性支气管肺发育不良并发呼吸衰竭而采用机械通气和NO吸入治疗。NO吸入浓度为 3～2 0ppm ,吸入时间为 1小时～ 35天。多普勒超声心动图利用三尖瓣返流或动脉导管未闭定量估测NO吸入前后肺动脉收缩压 (SPAP) ,同时测量上肢收缩压 (SBP) ,计算肺 /体压力 (Pp/Ps)比值。结果显示 :NO吸入 30～ 1 2 0分钟和 1 8～ 2 4小时后 ,SPAP分别由NO吸入前的 5 7± 1 1 .6mmHg降至 41± 1 0 8mmHg和 43± 1 8 2mmHg ;Pp/Ps分别由 0 87± 0 1 5降至 0 6 1± 0 1 5和 0 6 3± 0 2 1。NO吸入前后SBP无明显变化。NO吸入后卵圆孔、动脉导管和室间隔缺损水平右向左或双向分流较吸入前明显减少。结论 NO吸入治疗新生儿肺动脉高压安全有效。

To assess the effects of Doppler echocardiography on monitoring Pulmonary hypertension during inhalation of nitric oxide (iNO) in the treatment of neonatal repiratory failure, 8 neonates with pneumonia, NRDS, PPHN or congenital bronchi lung dysplasia hwithad respiratory failure in aggressive mechanical ventilation and iNO. Inhalation of NO was 3～20ppm and 1 hour～35 days. Doppler echocardiography combined with color flowmapping was utilized to quantitate systolic pulmonary artery pressure (SPAP) based on the regurgitation of tricuspid valve (TR) and PDA shunting. Systolic blood pressure (SBP) was read when echocardiography was carried out and a ratio of Pp/Ps was calculated. Results: shoued SPAP increased in all patients ranged at the level of 57±11.6mmHg prior to iNO and decreased to 41±10.8 mmHg in 30-120 min and 43±18.2 mmHg in 18-24 hr post initiation of iNO. Pp/Ps also decreased from 0.87±0.15 to 0.61±0.15 and 0.63±0.21. Right to left and bi directional shunt was decreased at the level of PFO, PDA and VSD. The strategy of iNO is effective and safe in the treatment of neonatal pulmonary hypertension. Doppler echocardiography is of importance in monitoring the efficacy of iNO.