经CPAP呼吸机吸入NO治疗新生儿持续性肺动脉高压的临床研究

Clinical research of inhaled NO through CPAP ventilator in the treatment of persistent pulmonary hypertension of the newborn

目的探讨应用经鼻持续正压通气(CPAP)吸入一氧化氮(NO)治疗新生儿持续性肺动脉高压(PPHN)的疗效及安全性。方法选取枣庄市妇幼保健院2017年6月至2022年5月新生儿监护室收治的经超声心动图确诊为PPHN的新生儿36例为研究对象,应用CPAP吸入NO,疗程到患儿撤离NO;记录吸入NO前后动脉血氧分压,血氧饱和度、血压、心率等,同时监测二氧化氮(NO_(2))、高铁血红蛋白数值(MHb),血小板和凝血功能。结果吸入NO前氧分压与经皮血氧饱和度低于吸入NO后1、24 h,差异有统计学意义(P<0.05);吸入NO前心率、血压、血小板及活化部分凝血活酶时间(APTT)与吸入NO后1、24 h比较,差异无统计学意义(P>0.05);36例患儿吸入N01、24、48、72 h后的MHb含量均<3%,NO_(2)浓度均<2.0 ppm,均在安全范围。结论经CPAP呼吸机吸入NO治疗PPHN安全有效。

Objective To investigate the efficacy and safety of inhaled nitric oxide(NO)through nasal continuous positive airway pressure(CPAP)in the treatment of persistent pulmonary hypertension of the newborn(PPHN).Methods A total of 36 infants admitted to and treated in the Neonatal Intensive Care Unit(NICU)of Maternity and Child Health Care of Zaozhuang from June 2017 to May 2022,who were diagnosed with PPHN by echocardiography,were included in the study.NO was inhaled with CPAP,and the course of treatment lasted until NO were evacuated from the infants.Before and after NO inhalation,the arterial partial pressure of oxygen,oxygen saturation,blood pressure,heart rate,etc.were recorded,and nitrogen dioxide(NO_(2)),methemoglobin(MHb)value and platelet and coagulation function were monitored simultaneously.Results The partial pressure of oxygen and transcutaneous oxygen saturation before NO inhalation were lower than those at 1 hour and 24 hours after NO inhalation,with statistically significant differences(P<0.05).There were no statistically significant differences in activated partial thromboplastin time(APTT),heart rate,blood pressure,platelets,and coagulation functions at 1 hour and 24 hours after NO inhalation when compared with those before NO inhalation(P>0.05).After inhaling NO for 1 hour,24 hours,48 hours and 72 hours,the MHb contents of 36 affected children were all less than 3%,and the concentrations of NO_(2)were all less than 2.0 ppm,all within the safe range.Conclusion The treatment of PPHN with NO inhalation through CPAP ventilator is safe and effective.