一氧化氮吸入治疗对胎粪吸入综合征患儿氧合功能及气道炎症反应的影响

目的 探讨吸入小剂量一氧化氮(NO)对胎粪吸入综合征(MAS)患儿氧合功能、气道炎症反应的影响.方法 选择河北省儿童医院新生儿科重症监护病房2005年2月至2007年4月收治的55例机械通气的MAS患儿,随机分为A组(机械通气+NO吸入治疗组)和B组(机械通气组),于治疗起始时(0 h)、治疗后24、72 h监测氧合指数(OI)、动脉/肺泡氧分压比值(a/APO2)以及肺动脉压(PAP)的变化.取静脉血和支气管肺泡灌洗液测定细胞因子IL-8、IL-10的含量.结果 A组患儿在吸入NO(10～20)×10-6]后OI、PAP逐渐下降(P<0.05),a/APO2逐渐上升(P<0.05).A组机械通气时间(77.38±13.97) h]明显低于B组(104.27±10.53) h](P<0.05).A组氧暴露时间(158.70±47.23) h]明显少于B组(202.15±61.92) h](P<0.05).A组平均住院天数(13.24±3.62) d]也明显低于B组(16.81±3.43) d](P<0.05).但是两组间病死率及气漏、肺出血、颅内出血(Ⅱ～Ⅳ级)的发病率间差异无显著性(P>0.05).血清及支气管肺泡灌洗液中IL-8水平于应用NO后24 h逐渐下降,IL-10水平逐渐增高,两者应用NO后差异均有显著性(P<0.05).结论 吸入NO作为治疗重症MAS的一种特殊疗法,具有降低PAP、改善氧合状态、缩短通气时间的作用.吸入NO可能在整体上调节MAS所致的肺部炎症反应,对机体有保护作用.

Efficacy of inhaled nitric oxide on oxygenation function and inflammatory response in neonates with MAS

Objective To evaluate effects of low-dose inhaled nitric oxide in earlier period of MAS on oxygenation function and inflammatory reaction.Methods Fifty-five newborns in the intensive care unit of Hebei Province Children Hospital from February 2005 to April 2007 were enrolled for study.All these MASpatients were mechanically ventilated and were divided randomly into Group A (mechanical ventilation+inhaled nitric oxide) and Group B(mechanical ventilation).OI,a/APO2 and PAP were monitored at 0 h,24 h,and 72 h after nitric oxide therapy.IL-8 and IL-10 were detected from venous blood and bronchoalveolar lavage fluid (BALF).A prospective study was carried on.Informed consent was obtained from parents before enrollment.The protocol and the informed consent forms were approved by the Institutional Review Board before patient enrollment.Results At 0 h,24 h and 72 h of Ino treatment,PAP were (76.20±12.96),(53.04±11.91),(41.76±11.51) mm Hg,respectively,OI were 13.10±3.00,10.99±2.37,8.37±0.27,whereas a/APO2 were 0.13±0.09,0.36±0.16,0.38±0.12 respectively.There were significant differences among OI,PAP and a/APO2 for different time points (P<0.05).Compared to group B,group A had shorter ventilation time (77.38±13.97) h vs (104.27±10.53) h].Oxygen exposure time (158.70±47.23) h vs (202.15±61.92) h] and hospital day(13.24±3.62)d vs (16.81±3.43) d] were shorter in group A than those in group B.IL-8 was decreased in serum and BALF.IL-10 was increased with significant difference(P<0.05).Conclusion As a special therapy for MAS,NO inhalation cuts down pulmonary artery pressure,improves oxygenation,shortens ventilation time,and maybe regulates lung inflammatory reaction.