新生儿急性呼吸窘迫综合征右心功能监测及早期保护的研究

Research on monitoring and early protection of right cardiac function in neonates with acute respiratory distress syndrome

目的探讨新生儿ARDS右心功能的变化以及米力农早期临床干预的意义。方法2018年01月至2020年03月南通大学第六附属医院新生儿科收治的新生儿ARDS患儿共68例,随机分为治疗组和对照组。治疗组早期予以米力农干预治疗。分别于米力农治疗前、干预治疗后24h、48h、72h动态监测治疗组与对照组患儿PAP、N-BNP、Rv-Tei等指标。结果米力农干预治疗前治疗组与对照组PAP、N-BNP、Rv-Tei比较差异无统计学意义(P>0.05);米力农干预治疗后24h、48h、72h PAP、N-BNP、Rv-Tei明显低于对照组,差异有统计学意义(P均<0.05);治疗组0h、24h、48h、72h时间点比较PAP、N-BNP、Rv-Tei呈明显下降趋势(P均<0.05),对照组0h、24h、48h、72h PAP、BNP、Rv-Tei差异无统计学意义(P均>0.05),治疗组平均住院时间、机械通气时间均低于对照组,差异有统计学意义(P均<0.05),PPHN发生率治疗组低于对照组,差异有统计学意义(P<0.05),病死率治疗组与对照组差异无统计学意义(P>0.05)。结论新生儿ARDS患儿早期存在右心功能损害,米力农早期治疗可以降低肺动脉压力,改善右心功能,提高抢救成功率,减少循环系统并发症的发生。

Objective To investigate the changes of right cardiac function in neonates with acute respiratory distress syndrome(ARDS)and the significance of early clinical intervention with milinone.Methods A total of 68 neonates with ARDS were enrolled in this study from January 2018 to March 2020 in Neonatology Department of the Sixth Affiliated Hospital of Nantong University,and they were randomly divided into the treatment group and the control group.The treatment group was treated with milinone at early stage.PAP,N-BNP,and Rv-Tei were dynamically monitored in the treatment group and the control group before milrinone treatment and 24h,48h,and 72h after milrinone intervention.Results There was no significant difference in PAP,N-BNP and Rv-Tei between the two groups before milinone intervention(all P>0.05).After milrinone intervention,the levels of PAP,N-BNP and Rv-Tei in the treatment group at 24 h,48 h and 72 h time points were significantly lower than those in the control group(all P<0.05).There was significant decrease in PAP,N-BNP and Rv-tei at 0h,24h,48h and 72h in the treatment group(all P<0.05).In the control group,there was no significant difference in PAP,N-BNP and Rv-Tei at 0h,24h,48h and 72h(all P>0.05).The average duration of hospital stay and mechanical ventilation in the treatment group was significantly shorter than that in the control group(P<0.05).The incidence of PPHN in the treatment group was significantly lower than that in the control group(P<0.05).There was no significant difference in mortality between the treatment group and the control group.Conclusion In neonates with ARDS,the right cardiac function can be impaired at early stage.Early treatment with milinone can reduce pulmonary artery pressure,improve right cardiac function,increase the rate of successful rescue,and reduce the complication of circulatory complications.