一氧化氮吸入治疗新生儿持续肺动脉高压临床研究  

EFFECT OF INHALED NITRIC OXIDE IN INFANTS WITH NEONATAL PERSISTENT PULMONARY HYPERTENSION

作　　者：姬东霞[1] 李珊[1] 陈琦[1] 何广艺[1] 罗文苑[1] 何英[1] 

机构地区：[1]广东省深圳市罗湖区人民医院儿科,518001

出　　处：《中国煤炭工业医学杂志》2007年第11期1262-1264,共3页Chinese Journal of Coal Industry Medicine

摘　　要：目的探讨一氧化氮(NO)吸入疗法治疗新生儿持续肺动脉高压的疗效。方法对32例持续肺动脉高压和呼吸衰竭患儿,在呼吸机机械通气情况下,将NO气源加入呼吸机环路中,NO浓度从20ppm(1ppm=0.001‰)开始,每经15～30min无效者增加5ppm,达到50ppm,30min仍无效者停用。有效者,持续6h后,每15min降低NO浓度5ppm,降为6ppm,持续24～72h。治疗时观察体循环氧合情况、平均肺动脉血流速度、肺动脉压力、血压、心率、高铁血红蛋白(MHb)、血小板及出凝血时间。结果32例患儿中28例(28/32,87.5%)吸入NO后血氧饱和度迅速上升,吸入30min后,平均肺动脉血流速度显著增加(P<0.001),以6ppm浓度维持24h后,氧合指数持续改善,肺动脉血流继续增加。停用后没有复发。而心率、血压、高铁血红蛋白未明显改变。结论吸入NO能显著降低新生儿肺动脉高压,改善氧合。对肺动脉高压有显著疗效,且未见明显副作用。Objective To discuss the effect of inhaled nitric oxide therapy in infant with neonatal persistent pulmonary hypertension （PPHN）. Methods 32 infants With PPHN and respiratory failure were initially treated with inhaled NO. During mechanical ventilation,NO was added into ventilator circle, the NO concentration began at 20ppm and was increased by 5ppm every 15-30minutes in cases who showed no improvement. The treatment would be stopped if the NO concentration arrived 50ppm but still with no effect. The relieved patients inhaled high concentration NO for 6 hours and then NO concentration was decreased by 5ppm every 30minutes. The NO concentration could be maintained at 6ppm for 24-72hours. Systemic oxygenation, mean pulmonary blood flow velocity, pulmonary arterial pressure （ PAP）, blood pressure, heart rate, methemoglobin and bleeding time were monitored before NO treatment. Results In 28 of 32 infants,oxygen saturation promptly improved （P〈0. 001 ）. PAP and oxygenation index decreased significantly （P〈0. 001）. mean pulmonary blood flow velocity（MPBFV） incread significantly（P〈0. 001） at 30 minutes following NO inhalation. After NO concentration maintained 6ppm for 24 hours,sustained improvement in oxygenation index,PAP and increase in MPBFV were achieved. No significant changes were found in heart rate, blood pressure, methemoglobin and bleeding time. Conclusion There is distinct effeot in shortterm inhaling low concentration NO in PPHN. there are no remarkable side effects.

关 键 词：一氧化氮 吸入治疗 持续肺动脉高压 新生儿 

分 类 号：R725.630.5[医药卫生—儿科]