一氧化氮联合高频振荡通气治疗新生儿持续肺动脉高压的疗效观察

Effect of Nitric Oxide Combined with High Frequency Oscillation Ventilation in Treatment of Persistent Pulmonary Hypertension of the Newborn

目的探讨一氧化氮（NO）联合高频振荡通气治疗新生儿持续肺动脉高压（PPHN）的疗效及安全性。方法对35例PPHN患儿在高频振荡通气下联合NO吸入,浓度从20×10-6mg/L（20ppm）开始,有效后可逐渐调低NO的浓度,降至5×10-6mg/L后维持3672 h。治疗时监测NO吸入前、吸入1 h、24 h和48 h后的pH值、肺动脉压力（PAP）、平均气道压（MAP）、氧分压（PaO2）、氧合指数（OI）、动脉导管前及动脉导管后的经皮血氧饱和度（SpO2）、血压、心率、吸入前后监测二氧化氮（NO2）的浓度。结果与吸入前比较,吸入1 h、24 h、48 h时MAP、PAP、OI均下降（P〈0.05）,动脉导管前、后SpO2、PaO2、pH值升高（P〈0.05）,心率、血压无明显改变（P〉0.05）。治疗期间,监测NO2均在安全范围内。结论 NO联合高频振荡通气治疗新生儿PPHN有显著疗效,而且无明显的毒副作用。

Objective To investigate the effect and safety of nitric oxide（ NO） combined with high frequency oscillation ventilation in the treatment of persistent pulmonary hypertension of the newborn（ PPHN）. Methods Thirty-five newborns with PPHN inhaled NO under high frequency oscillation ventilation,beginning with the NO density of 20 × 10- 6mg /L（ 20ppm） which decreased to 5 × 10- 6mg /L when took effect and then lasted for 36 to 72 hours. To test the pH value,pulmonary artery pressure（ PAP）,mean airway pressure（ MAP）,PaO2,oxygenation index（ OI）,transcutaneous SpO2 of anterior and posterior ductus arteriosus,blood pressure and heart rate before and 1,24,48 hours after inhaling NO as well as the density of nitrogen dioxide（ NO2） before and after inhaling NO. Results MAP,PAP OI 1,24,48 hours after inhaling NO decreased in contrast with those before inhaling NO（ P 〈 0. 05）,the transcutaneous SpO2 of anterior and posterior ductus arteriosus,PaO2 and pH value increased（ P 〈 0. 05）,and there were no significant changes in heart rate and blood pressure（ P 〈 0. 05）. The density of NO2 was normal during treatment. Conclusion NO combined with high frequency oscillation ventilation is significantly effective in the treatment of PPHN with little significant toxic and side-effect.