窒息新生儿肾损害及一氧化氮保护作用

为了解机械通气治疗的窒息新生儿肾损害的发生情况，比较不同窒息程度与肾损害的关系。并探讨一氧化氮（NO）吸入治疗对肾脏的影响。对机械通气治疗的41例窒息新生儿（轻度窒息19例，重度窒息22例），进行回顾性分析，其中13例同时予以NO吸入治疗。结果显示：41中17例（占41．5％），有不同程度的肾损害，重度窒息患儿肾损害发生率明显高于轻度窒息患儿（P＝0．014）。予以NO吸入治疗的窒息患儿肾损害的改善较未予以NO吸入治疗者明显，9例未用NO吸入治疗的肾损害患儿在机械通气治疗后2例肾损害好转，5例无好转，另2例未随访，8例用NO吸入治疗的肾损害患儿在NO吸入治疗后肾损害好转6例，另2例未随访，提示窒息新生儿肾损害的发生率相当高，而NO吸入治疗能较明显的改善窒息后的肾损害。

Study on the effect of asphyxia on the renal injure in newborn infants and the protective role of the nitric oxide(NO)

To estimate the incidence of renal injury in asphyxiated newborn infants,the relationship between the degree of asphyxia and the incidence of renal injury was compared and the protective role of the nitric oxide inhalation therapy was studied.41 asphyxiated newborn infants were treated with mechanical inhalation (including 19 cases with mild degree of asphyxia and 22 with severe degree of asphyxia). 13 of them were also received nitric oxide therapy at the same time.The indication for NO inhalation therapy was as following.That is:when the oxygen concentration inhaled was over 80% and kept on for 2 hours more.The PaO2 in arterial blood remained in less than 50mmHg and/or the oxygen saturation percen-tage in the arterial blood(SaO2)still kept on less than 80%.The diagnostic criterion for renal injury after asphyxia was consisted of hematuria,proteinuria,azotemia and acute renal failure.Renal injury in various degrees could be found in 17 of 41 asphyxiated newborn infants.The incidence of renal injury in severe type of asphyxiated cases was significantly higher than that happened in mild type of asphyxia (P=0.014).The degree of renal injury can be markedly improved in these asphyxiated newborn infants when they got NO inhalation therapy in comparison with those without NO inhalation in contrast,only 2 of 9 in the mechanical ventilation group had evidence of renal injury improvement. Other 5 cases had no evidence of improvement at all;2 cases lost follow-up while 6 of 8 cases in NO inhalation group had evidence of improvement in renal injury.Other 2 also lost follow-up.The incidence of renal injury in the asphyxiated newborn infants was very high and the NO inhalation therapy can greatly improve the severity of the renal injury.