一氧化氮吸入联合肺表面活性物质治疗新生儿难治性呼吸衰竭的疗效分析

目的探讨一氧化氮吸入（inhaled nitric oxide，iNO）联合肺表面活性物质（PS）对新生儿难治性呼吸衰竭的疗效。方法选择2007年7月-2011年10月安徽医科大学儿科临床学院治疗的新生儿难治性呼吸衰竭（NRDS）患儿7例，均经机械通气及PS治疗无效或加重的，给予吸入NO治疗。监测治疗前及治疗后1、12、24h的吸入氧浓度（FiO2）、经皮氧饱和度（SPO2）、动脉氧分压（PaO2）及氧合指数（OI）等数据。结果7例患儿经iNO治疗后1、12、24h的SP02[（89．57±4．68）、（91．28±1．38）（92．14±1．86）％]、Pa02[（56．85±9．63）、（62．42±8．99）（62．71±7．91）mmHg，1mmHg=0．133kPa]均高于治疗前，且Fi02[（65．00±13．22）、（52．85±14．09）（58．57±22．67）％]、OI[（16．21±2．82）、（11．84±4．11）（11．61±5．49）]均低于治疗前，差异均有统计学意义（P〈0．05）。结论机械通气联合PS治疗难治性呼吸衰竭疗效不满意的患儿可以加用iNO治疗，此疗法能够迅速改善氧合，纠正低氧血症，缩短高浓度氧使用时间，提高患儿抢救成功率，已经成为难治性呼吸衰竭一种有效治疗方法。

Curative effect analysis of n itric oxide inhalation combined with pulmonary surfactant in treatment of neonatal respiratory failure refractory

Objective To investigate the clinical effect of inhaled nitric oxide （inhaled nitric oxide, iNO） combined with pulmonary surfactant （PS） in treatment of neonatal respiratory failure refractory. Methods 7 newborn children with NRDS in Pediatrics Clinical College of Anhui Medical University from 2007 July to 2011 October were selected, all of them were found no effectiveness or exacerbation with mechanical ventilation and PS treatments and given iNO therapy. The data of fraction of inspired oxygen （FiO2）, transcutaneous oxygen saturation （SPO2）, arterial partial pres- sure of oxygen （PaO2） and oxygenation index （OI） were monitored before treatment and 1, 12, 24h after treatment, con- ditions of prognosis was observed. Results 1, 12, 24 hours after iNO therapy, SP02 [（89.57±4.68）, （91.28±1.38） （92.14±1.86）%] and Pa02 [（56.85±9.63）, （62.42±8.99）, （62.71±7.91）mm Hg, 1 mm Hg=0.133 kPa] in 7 NRDS newborn children were all higher than those before the iNO therapy, Fi02 [（65.00±13.22）, （52.85±14.09）, （58.57±22.67）%] and OI [（16.21±2.82）, （11.84±4.11）, （11.61±5.49）] in 7 NRDS newborn children were all lower than those before the iNO therapy, the differences were statistically significant （P 〈 0.05）. Conclusion Nitric oxide inhalation combined with pulmonary surfactant can rapidly improve oxygenation, correct hypoxemia, shorten the time of high con- centration oxygen use, increasing the success rate of rescue. This therapy has become an effective treatment method for refractory respiratory failure.