雾化吸入硝酸甘油治疗新生儿缺氧性肺动脉高压的疗效观察

目的 评价雾化吸入硝酸甘油(nitroglycerin,NTG)治疗新生儿缺氧性肺动脉高压的疗效. 方法 选择室息缺氧后发生肺动脉高压的新生儿33例,给予雾化吸入NTG,利用三尖瓣反流或动脉导管分流,采用多普勒超声心动图在治疗前后测定肺动脉收缩压(systolic pulmonary aterialpressure,咖),结合低氧血症情况评价其疗效;(1)完全缓解:终止NTG雾化吸入后,SPAP稳定于40 11lrTl Hg以下,低氧血症纠正,持续12 h以上.(2)好转:未达到上述标准,但SPAP下降幅度＞10mm Hg;低氧血症好转,经皮血氧饱和度(transcutaneous oxygen saturation,TcSaO2)＞90%,持续12 h以上.(3)无效:SPAP下降幅度＜10 mm Hg,低氧血症不能纠正. 结果 在33例患者中,完全缓解24例,好转7例,无效2例.每次雾化吸入NTG后,SPAP均有明显下降.第一次吸入NTG后0.5～1 h及3～4 h,SPAP从(62.15±15.36)mm Hg分别降至(43.46±10.32)mm Hg和(39.82±16.03)mm Hg;吸入治疗结束时和结束后12 h,SPAP继续下降至(34.88±7.33)mm Hg和(32.67±6.01)mm Hg.体循环收缩压在治疗期间波动于(55.91±16.07)mm Hg和(60.61±14.24)mm Hg之间,差异无统计学意义. 结论 雾化吸入NTG能有效治疗新生儿缺氧性肺动脉高压,起效迅速,有高度肺血管选择性,为新生儿肺动脉高压的治疗提供了新的治疗方法.

Efficacy of inhalation of nebulized nitroglycerin in neonatal pulmonary hypertension induced by asphyxia

Objective To evaluate the efficacy and safety of inhalation of nebulized nitroglycerin (NTG)in neonatal pulmonary hypertenaion induced by asphyxia.Methods A total of 33 neonatal patients with acute hypoxic pulmonary hypertension were treated with inhaled nebulized nitroglycerin.All patients underwent serial Doppler echocardiography to estimate systolic pulmonary artery pressure(SPAP)before,during and after application of inhalation of nebulized nitroglycerin.The efficacy of inhalation of nabulized NTG were evaluated as follows:(1)complete remission:transcutaneous oxygen saturation(TcSaO2)＞90%,and SPAP＜40 mm Hg,which lasted for 12 h after termination of inhalation of nitroglycerin;(2)improved:TeSaO2＞90%,and SPAP decreased 10 mm Hg or more,but still beyond 40 mm Hg;(3)invalid:TcSaO2＜90%,and SPAP decreased less than 10 mm Hg.Results Among 33 cases,complete remission was observed in 24 caes,improved in 7 cases,and invalid in 2 cases.SPAP decreased from(62.15±15.36)mmHg before initiation of inhalation of nitroglyeerin to(43.464±10.32)mm Hg at 30～60 min and(39.82±16.03)mm Hg at 3～4 h after inhalation,and continued to decrease to(35.46±8.01)mm Hg at the end and(32.66±5.07)mm Hg 12 h after termination of the treatment(P＜0.01).Systolic blood pressure did not change during the period.Conclusions Inhaled nebulized nitroglycerin was a highly selective pulmonary vasodilator,and effective in reducing pulmonary hypertension induced by asphyxia.This study provides a new treatment for neonatal pulmonary hypertension with encouraging outcome.