机械通气联合一氧化氮吸入治疗新生儿持续肺动脉高压的临床研究

目的探讨机械通气联合一氧化氮（nitric oxide,NO）吸入治疗新生儿持续肺动脉高压（persistent pulmonary hypertension of the new-born,PPHN）的有效性及安全性。方法诊断为PPHN的45例患儿,随机分为NO组（n=21）与对照组（n=24）,入院后给予常规对症支持治疗,NO组在机械通气的同时吸入NO,NO质量浓度从10 ppm开始,根据患儿的氧合改善情况调整浓度,有效者逐渐降低浓度到3 ppm,并撤离NO。结果 NO组与对照组在1h、12 h和24 h平均气道压、吸入氧浓度、动脉氧分压、OI值（F=192.7,P〈0.05）以及肺动脉压力（F=121.3,P〈0.05）的差异均有统计学意义;NO组在吸入NO1 h后OI即与吸入前的OI有明显差异（F=41.7,P〈0.05）,而对照组直到24 h差异才有统计学意义（F=19.7,P〈0.05）;两组间肺动脉压力在1 h（t=2.53,P〈0.05）、12 h（t=2.86,P〈0.05）和24 h（t=3.11,P〈0.05）差异均有统计学意义;两组间上机时间（t=3.11,P〈0.05）、氧暴露时间（t=2.98,P〈0.05）和住院天数（t=3.23,P〈0.05）差异均有统计学意义,而死亡（χ^2=0.23,P〉0.05）、气胸（χ^2=0.15,P〉0.05）和颅内出血（χ^2=0.00,P〉0.05）的发生率均无明显统计学意义。结论机械通气联合低流量短疗程吸入NO能迅速改善PPHN患儿的氧合,缩短患儿的上机时间、氧暴露时间及住院时间,并未增加主要并发症的发生。

A clinical study on inhaled nitric oxide and mechanical ventilation in treatment of neonates with persistent pulmonary hypertension

Objective： To investigate effects and safety of inhaled nitric oxide and mechanical ventilation in persistent pulmonary hypertension（PPHN） and outcome of babies with PPHN.Methods： Forty-five patients diagnosed as PPHN（≥70 mmHg） were included in the study.The patients were randomized to receive either NO（NO Group,n=21） or no NO（Control Group,n=24）.All the patients were treated routinely,but without Vasoactive drugs.Patients in the NO Group were treated with inhaled NO at 10ppm initially.The response to inhaled NO was assessed according to the increase in artetial PaO2 after exposure to the starting concentration for 1hour and reduced the concentration according to patients＇ condition to 3ppm,and then withdrew inhaled NO.Results： There was no significant difference in gestational age,birth weight,gender ratio,age at admission in hour,c-section delivery between the two groups,and no significant difference was found in respiratory mechanics parameters between the two groups at baseline.The duration of NO was 33.3±5.8 hours.One hour later,OI and PAP of the NO group decreased significantly,OI：F=41.7,P〈0.05;PAP： F=21.7,P〈0.05）,while in the control group the difference was not found until 24 hours（OI：F=19.7,P〈0.05;PAP：F=98.6,P〈0.05）.There were significant differences in PAP at 1,12,24 hours between the two groups（1h： t=2.53,P〈0.05;12h： t=2.86,P〈0.05;24h： t=3.11,P〈0.05）.Compared to the controls,ventilation time（t=3.11,P〈0.05）,exposure time to oxygen（t=2.98,P〈0.05）,hospital stay（t=3.23,P〈0.05） were shorter,whereas mortality（χ^2=0.23,P〈0.05）,the incidence of pneumothorax（χ^2=0.15,P〈0.05） and IVH（χ^2=0.00,P〈0.05） were not significantly different between the groups.Conclusion： Inhaled NO and mechanical ventilation can effectively improve the oxygenation,decrease pulmonary pressure and shorten the ventilation time and hospital stay and oxygen exposure without augmentation of risk of pneumothorax,IVH and mortality in neonatal with PPHN.