一氧化氮不同通气方式治疗新生儿持续肺动脉高压疗效评价

Nitric oxide in different ventilation treatment efficacy evaluation of sustained neonatal pulmonary hypertension

目的探讨一氧化氮（NO）联合不同振荡通气方式治疗新生儿持续肺动脉高压（PPHN）的疗效及安全性。方法将我院94例PPHN患儿按确诊、治疗的时间先后顺序随机分为观察组和对照组各47例。观察组采用NO＋高频通气,NO质量浓度由20ppm开始,有效后可逐渐调低NO浓度,降至5×10-6 mg/L后维持36～72h;对照组采取NO＋常频通气,NO质量浓度由20ppm开始,最大可增至40ppm,有效者可每4h降低NO浓度5ppm,直至6ppm,以此低浓度维持36～72h,分别在治疗前、治疗3d后监测两组患儿PaO2和肺动脉收缩压（SPAP）变化。结果两组患儿在治疗3d后,PaO2分别与其治疗前比较,均有显著性提高（P〈0.05）,而SPAP分别与其治疗前比较,均有显著性降低（P〈0.05）;治疗3d后,两组患儿之间PaO2和SPAP比较,差异均无统计学意义（P〉0.05）,观察组患儿治疗3d后的治愈率明显高于对照组（P〈0.05）;两组患儿在治疗中均未出现不良反应。结论 NO联合高频和常频振荡通气治疗PPHN均有显著疗效,且无明显的毒副作用,但NO＋高频通气对于PPHN的短期治愈率则明显优于NO＋常频通气。

Objective To investigate the role of nitric oxide （NO） of persistent pulmonary hypertension combined with different oscillatory ventilation therapy for neonatal （PPHN） of the efficacy and safety of. Methods 94 patients in our hospital in children with PPHN diagnosis were randomly divided into the control group （47 cases） and The observation group （47 cases）. The observation group adopted NO＋ high frequency ventilation. The mass concentration of NO from the 20ppm started. The effective concentration of NO after becoming lower and lower, to 5×10-6 mg/L after the maintenance of 36 ～ 72 h. While the control group adopted NO＋ normal frequency ventilation, NO mass concentration by starting with 20ppm. The maximum can be increased to 40ppm. Every 4H effective can decrease the concentration of NO 5ppm. Until 6ppm, the low concentration was maintained for 36 ～ 72h. The two groups were monitored PaOz and pu[monary artery systolic pressure respectively before treatment after treatment for 3D （SPAP） changes. Results PaO2 3 days after treatment were significantly increased （P〈0.05）. SPAP 3 days after treatment were significantly decreased （P〈0.05）. PaO2 and SPAP after treatment had no statistical significance between the two groups （P〈0.05）. The cure rate of observation group was higher than that of the control group （P〈0.05）. The two groups showed no adverse reaction. Conclusion NO combined with high frequency and constant frequency oscillation ventilation in treatment of PPHN has significant effect and no obvious side effects, but the short term cure rate of the NO＋ high frequency ventilation for PPHN is significantly better than that of NO-~ normal frequency ventilation.