iNO联合HFOV在新生儿肺动脉高压中的应用及其对NGAL、NT-proBNP和ARNT的影响

Application of iNO combined with HFOV in neonatal pulmonary hypertension and its effect on NGAL,NT-proBNP,and ARNT

目的探讨一氧化氮吸入(inhalation of nitric oxide,iNO)联合高频振荡通气(High frequency oscillatory ventilation,HFOV)治疗新生儿肺动脉高压的价值及对中性粒细胞明胶酶相关载脂蛋白(Neutrophil gelatinase-associated apolipoprotein,NGAL)、氨基末端B型脑钠肽前体(N-terminal B-type pro-brain natriuretic peptide,NT-proBNP)、芳香烃受体核转位蛋白(Aryl hydrocarbon receptor nuclear translocator,ARNT)表达水平的影响。方法选取我院于2018年1月-2021年1月收治的164例肺动脉高压新生儿为研究对象,按照随机数字表法分为研究组和对照组,各82例。对照组给予米力农+HFOV治疗,研究组给予iNO+HFOV治疗。比较两组患儿治疗效果,治疗前、后新生儿动脉血气、氧合指数、通气指标以及NGAL、NT-proBNP和ARNT水平变化情况。结果研究组治疗有效率明显高于对照组(92.68%vs 81.71%),有创和无创通气时间以及氧暴露时间均短于对照组,差异有统计学意义(P<0.05)。主要并发症为上呼吸道感染、肺出血、肺炎、气漏、颅内出血以及低血压,其中研究组上呼吸道感染、肺炎发生率低于对照组(P<0.05)。治疗后两组患儿PaO_(2)、OI均明显增加,而PaCO_(2)明显降低,其中研究组动脉血气指标水平均优于对照组(P<0.05)。治疗后两组患儿血浆NGAL、NT-proBNP和ARNT水平均明显降低,其中研究组血浆NGAL、NT-proBNP和ARNT水平明显低于对照组(P<0.05)。结论iNO联合HFOV治疗新生儿肺动脉高压效果良好,可有效改善新生儿动脉血气状态、氧合状况,降低NGAL、NT-proBNP和ARNT水平,以及缩短有创和无创通气时间,且安全性较好。

Objective To explore the value of nitric oxide inhalation(iNO)combined with high-frequency oscillatory ventilation(HFOV)in the treatment of neonatal pulmonary hypertension and its effect on NGAL,NT-proBNP,and ARNT expression levels.Methods A total of 164 neonates with pulmonary hypertension admitted to our hospital from January 2018 to January 2021 were selected as the research objects and were divided into study group and control group according to the random number table method,with 82 cases in each.The control group was given milrinone+HFOV treatment,and the study group was given iNO+HFOV treatment.The treatment effects of the two groups of children were compared,including the changes of neonatal arterial blood gas,oxygenation index,ventilation index,and levels of NGAL,NT-proBNP,and ARNT before and after treatment.Results The effective rate of treatment in the study group was significantly higher than that in the control group(92.68%vs 81.71%),while the time of invasive and non-invasive ventilation and the oxygen exposure time was shorter than those of the control group,and the difference was statistically significant(P<0.05).The main complications were upper respiratory tract infection,pulmonary hemorrhage,pneumonia,air leakage,intracranial hemorrhage,and hypotension.The incidence of upper respiratory tract infection and pneumonia in the study group was lower than that in the control group(P<0.05).After treatment,PaO_(2) and OI were significantly increased in the two groups of children,while PaCO_(2) was significantly decreased,and the levels of arterial blood gas in the study group were better than those in the control group(P<0.05).After treatment,the levels of NGAL,NT-proBNP,and ARNT in the two groups were significantly reduced,and the levels of plasma NGAL,NT-proBNP,and ARNT in the study group were significantly lower than those in the control group(P<0.05).Conclusion iNO combined with HFOV has a good effect in the treatment of neonatal pulmonary hypertension,which can effectively improve neonatal arterial blood gas status and oxygenation status,reduce the levels of NGAL,NT-proBNP,and ARNT,and shorten the time of invasive and non-invasive ventilation,with good safety.