低分子肝素辅助治疗D-二聚体升高的新生儿继发性肺动脉高压的疗效

Efficacy of Low Molecular Weight Heparin in the Adjuvant Treatment of Secondary Pulmonary Hypertension in Neonates with Elevated D-Dimer

目的:探讨低分子肝素(LMWP)辅助治疗D-二聚体升高的新生儿继发性肺动脉高压(PH)的疗效。方法:选取2020年6月至2023年5月南方医科大学附属花都医院新生儿重症监护室收治的100例血浆D-二聚体>1 000 ng/mL的继发性PH新生儿。基于不同氧疗方式分为经鼻持续气道正压通气(NCPAP)组和有创机械通气(IMV)组各50例,两组患儿根据是否加用LMWP治疗,按入组顺序再分为观察组A、观察组B、对照组A、对照组B亚组各25例。比较分析各组患儿72小时内肺动脉收缩压(PASP)、血浆D-二聚体水平及不良反应发生情况。结果:各组患儿胎龄、日龄、基础疾病等基线资料比较差异均无统计学意义(P>0.05)。观察组A、B治疗后D-二聚体中位数水平均较其相对应的对照组A、B及治疗前明显降低(P均<0.05),对照组A、B的D-二聚体中位数水平比较差异无统计学意义(P均>0.05)。观察组A、B治疗总有效率分别为88%、84%,高于其相对应的对照组A、B(P均<0.05)。结论:高凝状态或血栓形成引起的血管内梗阻可能是新生儿继发性PH的重要原因,加用LMWP辅助治疗可提高疗效。

Objective:To probe into the efficacy of low molecular weight heparin(LMWP)in the adjuvant treatment of secondary pulmonary hypertension(PH)in neonates with elevated D-dimer.Methods:From Jun.2020 to May 2023,a total of 100 neonates with secondary PH and plasma D-dimer>1,000 ng/mL hospitalized in neonatal intensive care unit of Huadu Hospital Affiliated to Southern Medical University were extracted to be divided into nasal continuous airway positive pressure(NCPAP)group and invasive mechanical ventilation(IMV)group based on different oxygen therapy methods,with 50 cases in each group.Both groups were divided into the observation group A and B,and control group A and B subgroups according to whether or not receiving LMWP therapy,with 25 cases in each group.Pulmonary artery systolic blood pressure(PASP),D-dimer level and occurrence of adverse drug reactions in each group were compared and analyzed within 72 h.Results:There were no significant differences in gestational age,age,and underlying diseases among all groups(P>0.05).The median level of D-dimer in observation group A and B after treatment were significantly lower than those in corresponding control group A and B and before treatment(P<0.05).The median level of D-dimer in control group A and B were lower than those before treatment,yet there was no statistically significant difference(P>0.05).The total effective rate of observation group A and B was respectively 88%and 84%,higher than that of corresponding control group A and B(P<0.05).Conclusion:Intravascular obstruction induced by hypercoagulability or thrombosis may be an important cause of neonatal secondary PH,and the adjuvant treatment with LMWP can improve the curative effect.