胎龄<34周早产儿一氧化氮吸入的研究进展

Recent research on inhaled nitric oxide in preterm infants with a gestational age of<34 weeks

一氧化氮作为血管平滑肌细胞舒张的信使分子,吸入一氧化氮(inhaled nitric oxide,iNO)能够扩张肺部血管,降低肺血管阻力,从而降低肺动脉压力,而对体循环压力没有影响。国内外指南均推荐iNO用于足月儿和晚期早产儿,已证实对足月儿和晚期早产儿持续肺动脉高压和低氧性呼吸衰竭具有明显效果。但是近年来的研究显示,iNO用于胎龄<34周早产儿的超适应证治疗越来越多。该文就iNO治疗胎龄<34周早产儿的有效性、安全性、应用时机、剂量、撤离方式和与血管活性药物联合使用的国内外研究进展作一综述,以期为临床应用提供参考。

Nitric oxide is a messenger molecule for vasodilation of vascular smooth muscle cells,and inhaled nitric oxide(iNO)can dilate pulmonary blood vessels and reduce pulmonary vascular resistance,thereby reducing pulmonary artery pressure,but with no influence on systemic circulation pressure.Guidelines in China and overseas recommend the use of iNO in full-term infants and late preterm infants,and it has been proved that it has a marked effect on persistent pulmonary hypertension and hypoxic respiratory failure in such infants.However,recent studies have shown that there is an increase in the off-label use of iNO in preterm infants with a gestational age of<34 weeks.This article reviews the research progress on the efficacy,safety,timing,dose,and withdrawal mode of iNO and its combination with vasoactive drugs in the treatment of preterm infants with a gestational age of<34 weeks in China and overseas,so as to provide a reference for clinical application.