常频通气联合一氧化氮吸入治疗新生儿持续肺动脉高压  

Effect of conventional ventilation and inhaled nitric oxide in infants with persistent pulmonary hypertension of the newborn

作　　者：周东元 李梅 

机构地区：[1]哈尔滨市儿童医院ICU,150010

出　　处：《中国小儿急救医学》2010年第3期230-232,共3页Chinese Pediatric Emergency Medicine

基　　金：黑龙江省卫生厅指导性计划项目（2003-190）

摘　　要：目的 探讨常频通气联合一氧化氮吸入（iNO）治疗新生儿持续肺动脉高压（PPHN）的疗效.方法 对22例确诊为PPHN且入院时采取常频通气疗效不满意的患儿给予iNO.NO初始吸入浓度上,20例为（10～20）×10^-6,2例为（20～40）×10^-6.当SpO2≥93%并已经稳定20min以上,开始下调呼吸机参数,并逐渐下调NO吸入浓度.当NO吸入浓度降至（5～10）×10^-6时,再持续2～3h后,若PaO2〉55mm Hg（1 mm Hg=0.133 kPa）、SpO2〉93%时停止吸入.在NO吸入前和吸入后1～6 h分别进行血气分析,连续记录生命体征、SpO2和监测NO2值等.结果 20例在吸人NO后5～20 min左右SpO2逐渐升高,临床缺氧状态逐步改善.有效率达91%.吸入NO 1～6 h,SpO2、PaO2分别由吸入前的（76.3±13.3）%、（46.4±10.1）mm Hg升到（94.4±2.9）%和（92.8±24.7）mm Hg,FiO2由（0.9±0.1）降至（0.6±0.1）,差异均有非常显著性（P〈0.001）.患儿生命体征平稳,未发现急性合并症.全组治愈18例,治愈率达82%,自动放弃4例.结论 iNO能有效地缓解PPHN患儿的乏氧状态.提高氧分压和治愈率.NO吸入不良反应小、易操作.iNO初始吸人浓度以（10～20）×10^-6开始为宜,极个别病例可以（20～40）×10^-6开始.Objective To evaluate the effects of inhaled nitric oxide （iNO） therapy combined with conventional ventilation in the infants with persistent pulmonary hypertension of the newborn （PPHN）. Methods NO inspiration was added for 22 infants with PPHN ventilated with FiO2 ≥0. 9,PIP≥30 cm H2O, PEEPs〉3 cm H2O,RR≥50 bpm for 4 -6 hours,with SpO2 still 〈 90% and PaO2 〈55 mm Hg. The iNO concentmtion started at （10-20） x 10-6 for 20 infants,and （20 -40） ×10^-6 for 2 infants. The iNO would be stopped when the concentration reached 40 ×10^-6 without any sign of improvement. The SpO2 ,blood gas analyses,blood pressure, heart rate and NO2 concentration were momitored during therapy and the resulting data compared to readings before administration of iNO. Results Clinical situation were significantly improved in 20 （91%） of the infants with SpO2 gradually going up after 10 minutes of iNO. Before iNO ,mean FiO2 was 0. 9 ± 0. 1, SpO2 was （76. 3 ± 13.3 ） %, and PaO2 was （ 46. 4± 10. 1 ）mm Hg. From 1 to 6 hours after iNO, SpO2 increased to（95. 1 ±3.8）% ,PaO2 increased to（92. 8±24.7） mm Hg,FiO2 decreased to 0.6 ±0. 1. The differences were significant （ P 〈 0. 01 ）. Eighteen of 22 （ 82% ） infants surviving. Conclusion iNO is effective in alleviating PPHN in infants. There are no remarkable side effects. It is more beneficial to start the iNO concentration at （10 -20） ×10^-6 while some infants may need NO concentration at up to （20 -40）×10^-6.

关 键 词：一氧化氮 吸入治疗 持续肺动脉高压 常频机械通气 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]