一氧化氮吸入联合高频振荡通气对新生儿持续肺动脉高压治疗的临床研究

Clinical study of nitric oxide inhalation combined with high-frequency oscillatory ventilation in the treatment of persistent pulmonary hypertension

目的探讨一氧化氮吸入联合高频振荡通气治疗新生儿持续肺动脉高压(PPHN)的临床效果。方法前瞻性选取2020年1月至2022年7月邢台市第三医院收治的120例PPHN患儿,按照随机数字表法分为A、B、C组,每组各40例,其中A组采用高频振荡通气治疗,B组采用米力农联合高频振荡通气治疗,C组采用一氧化氮吸入联合高频振荡通气治疗。对比三组患儿治疗前后的肺动脉收缩压(PASP)、动脉血氧分压(PaO 2)、动脉血二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))、超声心动图及肺动脉参数、氧合指数(OI)、吸入氧浓度(FiO 2)、临床疗效。结果治疗后,B、C组患儿的PSAP、PaCO_(2)低于A组,B、C组患儿的PaO 2、SaO_(2)测定值高于A组,差异均有统计学意义(P<0.05);B、C组患儿的PSAP、PaO 2、PaCO_(2)、SaO_(2)测定值比较,差异无统计学意义(P>0.05);治疗前,A、B、C三组的左心房内径、左心室内径、右心房内径、右心室内径、肺动脉内径测定值比较,差异无统计学意义(P>0.05);治疗后,B、C组患儿的右心房内径、右心室内径、肺动脉内径测定值低于A组,差异均有统计学意义(P<0.05);B、C组患儿的左心房内径、左心室内径、右心房内径、右心室内径、肺动脉内径测定值比较,差异无统计学意义(P>0.05);治疗前,A、B、C三组的OI、FiO 2测定值测定值比较,差异无统计学意义(P>0.05);治疗后,B、C组患儿的OI值高于A组,B、C组的FiO 2低于A组,差异均有统计学意义(P<0.05);B、C组患儿的OI、FiO 2测定值比较,差异无统计学意义(P>0.05);B、C组患儿的机械通气时间、氧疗时间、住院时间短于A组,C组患儿的机械通气时间、氧疗时间、住院时间短于B组,差异均有统计学意义(P<0.05)。经过3 d治疗,B、C组的总体疗效分布优于A组,差异均有统计学意义(P<0.05);B组和C组的疗效比较,差异无统计学意义(P>0.05)。结论一氧化氮吸入联合高频振荡通气治疗PPHN的临床效果肯定,能显著缩短机械通气时间、氧疗时间、住院时间。

Objective To explore the clinical effect of nitric oxide inhalation combined with high-frequency oscillatory ventilation in the treatment of persistent pulmonary hypertension of the newborn(PPHN).Methods A total of 120 newborns with PPHN admitted in the Third Hospital of Xingtai City from January 2020 to July 2022 were selected and divided into groups A,B,and C according to the random number table method treatment methods.Group A received high-frequency oscillatory ventilation,group B received milrinone combined with high-frequency oscillatory ventilation,and group C received nitric oxide inhalation combined with high-frequency oscillatory ventilation;The pulmonary systolic pressure(PASP),arterial partial oxygen pressure(PaO 2),arterial partial carbon dioxide pressure(PaCO_(2)),blood oxygen saturation(SaO_(2)),pulmonary artery and echocardiographic parameters,oxygenation index(OI),inhaled oxygen concentration(FiO 2),and clinical efficacy of the three groups of children before and after treatment were compared.Results After treatment,the PSAP and PaCO_(2) of patients in groups B and C were lower than those in group A,while the measured values of PaO 2 and SaO_(2) of patients in groups B and C were higher than those in group A,with a statistically significant difference(P<0.05);There was no statistically significant difference in the measured values of PSAP,PaO 2,PaCO_(2),and SaO_(2) between group B and group C(P>0.05);Before treatment,there was no statistically significant difference in the measured values of left atrial diameter,left ventricular diameter,right atrial diameter,right ventricular diameter,and pulmonary artery diameter among groups A,B,and C(P>0.05);After treatment,the measured values of right atrial diameter,right ventricular diameter,and pulmonary artery diameter in group B and C were lower than those in group A,with a statistically significant difference(P<0.05);There was no significant difference in the measured values of left atrial diameter,left ventricular diameter,right atrial diameter,right ventricular diameter,and pulmonary artery diameter between groups B and C(P>0.05);Before treatment,the difference between the measured values of OI and FiO_(2 )in groups A,B,and C was not statistically significant(P>0.05);After treatment,the OI value of patients in Groups B and C was higher than that in Group A,while the FiO_(2 )in Groups B and C was lower than that in Group A,with a statistically significant difference(P<0.05);There was no statistically significant difference in the measured values of OI and FiO_(2 )between group B and group C(P>0.05);The mechanical ventilation time,oxygen therapy time,and hospitalization time of patients in Group B and C were lower than those in Group A,while the mechanical ventilation time,oxygen therapy time,and hospitalization time of patients in Group C were lower than those in Group B,with a statistically significant difference(P<0.05);After 3 days of treatment,the overall efficacy distribution of Group B and Group C was better than that of Group A,with a statistically significant difference(P<0.05);There was no statistically significant difference in the efficacy between Group B and Group C(P>0.05).Conclusion The clinical effect of nitric oxide inhalation combined with high-frequency oscillatory ventilation in the treatment of neonatal pulmonary hypertension is affirmative,which can significantly shorten the time of mechanical ventilation,oxygen therapy,and hospitalization.