一氧化氮吸入联合高频振荡通气治疗新生儿肺动脉高压疗效分析

The efficacy of inhaled nitric oxide combined with high frequency oscillatory ventilation for persistent pulmonary hypertension of the newborn

目的探讨一氧化氮吸入(i NO)联合高频振荡通气(HFOV)治疗新生儿持续肺动脉高压(PPHN)的临床疗效。方法回顾性分析2010年1月至2013年12月本院新生儿重症监护病房收治的PPHN患儿临床资料,根据不同时间段治疗措施不同分为HFOV组、常频机械通气(CMV)+i NO组、HFOV+i NO组。记录并比较各组患儿治疗前、治疗2、12、24 h的吸入氧浓度(Fi O2)、氧合指数(OI)、肺动脉压力,以及呼吸机使用情况、住院时间、症状变化及转归。结果治疗2、12、24 h,HFOV+i NO组Fi O2、OI、肺动脉压力均低于CMV+i NO组和HFOV组,CMV+i NO组低于HFOV组[2 h Fi O2:(0.43±0.15)比(0.58±0.11)、(0.71±0.13),OI:(17.1±5.6)mm Hg比(20.3±6.2)mm Hg、(22.6±6.4)mm Hg,肺动脉压力:(46.2±4.6)mm Hg比(51.3±4.4)mm Hg、(58.3±3.7)mm Hg;24h Fi O2:(0.26±0.14)比(0.32±0.16)、(0.42±0.13),OI:(8.4±4.2)mm Hg比(11.6±4.6)mm Hg、(13.8±3.8)mm Hg,肺动脉压力:(15.3±4.4)mm Hg比(24.5±4.5)mm Hg、(35.6±3.6)mm Hg,P<0.05]。HFOV+i NO组机械通气时间、氧疗时间及住院时间均短于CMV+i NO组和HFOV组,CMV+i NO组短于HFOV组,差异有统计学意义(P<0.05);各组患儿病死率及Ⅲ度以上颅内出血发生率差异无统计学意义(P>0.05)。结论早期i NO联合HFOV治疗PPHN疗效显著,能迅速改善肺动脉高压患儿的氧合情况,显著缩短患儿的上机时间、氧暴露时间及住院时间,但对患儿病死率及Ⅲ度以上颅内出血发生率没有影响。

Objective To determine the clinical effects of inhale nitric oxide（ i NO） combined with high frequency oscillatory ventilation（ HFOV） for persistent pulmonary hypertension of the newborn（ PPHN）. Methods Clinical data of PPHN in NICU of our hospital from January 2010 to December2013 were retrospectively studied. These infants were assigned into three groups based on different therapeutic strategies： HFOV group,conventional mechanical ventilation（ CMV） ＋ i NO group and HFOV ＋ i NO group. Their Fi O2,oxygenation index（ OI） and pulmonary artery pressure（ PAP） before and after 2 h,12 h,24 h of treatment were compared. The application of ventilator,hospital stay duration,complications and clinical outcomes were also compared. Results 2 h,12 h and 24 h after treatment,the Fi O2,OI and PAP in HFOV ＋ i NO group were lower than CMV ＋ i NO group and HFOV group,while CMV ＋ i NO group lower than HFOV group. Mechanical ventilation,oxygen therapy and hospital stay duration in HFOV ＋ i NO group were shorter than CMV ＋ i NO group and HFOV group（ P〈0. 05）. However,no statistically significant differences existed among the three groups on mortality rate and the incidence of above third degree intracranial hemorrhage（ P〉0. 05）. Conclusions i NO ＋HFOV is effective for PPHN. The combination therapy can rapidly and effectively improve oxygenation in children with pulmonary hypertension,and shorten mechanical ventilation time,oxygen exposure and hospital stay duration.