机械通气联合一氧化氮治疗新生儿持续肺动脉高压临床分析

Clinical analysis on mechanical ventilation combined with inhaled nitric oxide in the treatment of persistent pulmonary hypertension of newborn

目的探讨新生儿持续肺动脉高压(persistent pulmonary hypertension of newborn,PPHN)的主要病因及机械通气联合一氧化氮(NO)治疗的临床疗效。方法回顾性分析2008年1月至2014年5月我院收治的26例PPHN患儿的围产期情况、原发病以及机械通气联合NO治疗前后的主要呼吸机参数、血气指标、心率等。结果 26例PPHN患儿中有窒息史14例(53.85%),羊水污染史10例(38.46%),原发病为肺部疾病21例(80.77%)。19例采用机械通气联合NO治疗后,Pa O2/Fi O2比值、Sp O2和Pa O2随时间延长逐渐增高,差异有统计学意义(P<0.05);Fi O2在6 h时较前增加,此后逐渐降低,血气分析指标p H、Pa O2、HCO3-、Sp O2治疗前后差异均有统计学意义(P<0.05)。26例患儿中,4例入院3 h内自动出院未完成治疗。19例机械通气联合NO治疗的患儿中,最终治愈13例,好转1例,治疗有效率73.68%。1例合并高铁血红蛋白血症,1例血小板计数减少,2例合并消化道出血。结论围生期窒息、羊水污染、肺部疾病仍是PPHN的主要病因,早期机械通气联合NO吸入治疗可有效改善患儿氧合状况和代谢性酸中毒。

Objective To explore the main causes of persistent pulmonary hypertension of newborn （ PPHN） and the effects of mechanical ventilation combined with inhaled nitric oxide （ iNO） in the treatment of the disease .Methods The perinatal conditions , primary disease and main ventilator parameters ,arterial blood gas indexes and heart rate before and after treatment in 26 PPHN cases were retrospectively analyzed.These patients were admitted to our hospital from Jan .2008 to May.2014.Results Of these patients,14 cases（53.85%） with a history of perinatal asphyxia ,10 cases（38.46%） had amniotic fluid contamination and 21 cases（80.77%） had primary etiologies of pulmonary diseases .Further,19 patients received mechanical ventilation combined with iNO .After six-hour of therapy,values of SpO2and PaO2were significantly greater than that of pre-therapy（P＜0.05）.The value of FiO2 was increased at the time point of 6 h and then fell off.PaO2/FiO2 was gradually increased and pH,PaO2,HCO3-and SpO2were significantly different be-tween before and after therapy .Of the 26 cases,excluding 4 cases with less than 3-hour-hospitalization,13 were cured and 1 discharged with improvement .The therapeutic effective rate was 73.68%.One patient developed methemoglobinemia , one had thrombocytopenia and 2 developed digestive tract hemorrhage .Conclusion Perinatal asphyxia ,amniotic fluid contamination and pulmonary diseases still are the main causes of PPHN .Timely mechanical ventilation combined with iNO therapy can effectively improve the hemoglobin oxygen saturation and swiftly correct metabolic acidosis .