吸入一氧化氮对急性呼吸窘迫综合征患儿肺动脉压力的影响  

Effect of inhaled nitric oxide for pulmonary artery pressure in children with acute respiratory distress syndrome

作　　者：徐梅先[1] 张军桥[1] 霍习敏[1] 李坤芬[1] 田利远[1] 冯春艳[1] 曹利静[1] 孙慧[1] 

机构地区：[1]河北省儿童医院重症监护科,河北石家庄050031

出　　处：《临床荟萃》2011年第1期28-30,共3页Clinical Focus

摘　　要：目的观察吸入一氧化氮(NO)在急性呼吸窘迫综合征(ARDS)治疗中对肺动脉压力的影响。方法 20例确诊ARDS患儿在进行药物治疗、机械通气的同时均进行吸入外源性NO治疗,NO初始治疗浓度为10×10-6,通过多普勒超声心动图分别计算吸入NO前,吸入后0.5、1、12、24、48小时等不同时刻的肺动脉压力(PAP),直至某个时刻NO治疗效果不明显时,则将治疗浓度减为原浓度的50%,每2小时递减50%,直至停用,分别记录各时间点的PAP值。结果吸入前PAP均值为59.20 mmHg(1 mmHg=0.133 kPa),吸入NO后0.5、1、12、24、48小时PAP均值分别为53.40 mmHg、48.10 mmHg、42.80 mmHg、36.60 mmHg、35.30 mmHg,与吸入前比均明显下降(P<0.05)。在吸入NO后48小时内PAP平均值呈递减趋势,但吸入后24小时与48小时相比,差异无统计学意义(P>0.05);50小时吸入NO浓度减为原来的50%后PAP平均值为37.70 mmHg,与48小时相比,PAP增高且两组差异有统计学意义(P<0.05),52小时NO浓度再减为50%后与50小时相比,PAP差异无统计学意义(P>0.05),54小时停止吸入后PAP(平均值为40.30 mmHg)虽较前反弹但仍较吸入前明显减低。结论 NO对ARDS导致的肺动脉压力增高有治疗作用,吸入浓度为10×10-6的NO,24小时内可有效减低PAP,维持原浓度继续吸入则无明显效果。Objective To investigate the effect of inhaled nitric oxide（NO） for pulmonary artery pressure in children with acute respiratory distress syndrome（ARDS）.Methods 20 children diagnosed with ARDS were treated with drug therapy,mechanical ventilation and exogenous NO inhalation.The initial treatment concentration of NO was 10×10-6.The pulmonary artery pressure（PAP） was recorded by Doppler echocardiography before NO inhalation,0.5 hour after inhalation,1 hour,12 hours,24 hours after inhalation,respectively.At some time the clinical effect was not obvious,we reduced the concentration of NO to 50% every two hours.PAP was recorded at each time point.Results The mean of PAP before NO inhalation was 59.20 mmHg,while means of PAP was lowered obviously at 0.5 hour,1 hour,12 hours,24 hours,48 hours after inhaled NO than before（P〈0.01）.They were 53.40 mmHg,48.10 mmHg,42.80 mmHg,36.60 mmHg,35.30 mmHg respectively.The mean of PAP decreased progressively within 48 hours.But there were no significant differce between 24 hours and 48 hours after inhalation（P〉0.05）.At 50 hours when the concentration of NO had reduced to 50%,the mean of PAP was 37.70 mmHg,there was no significant difference between 50 hours and 48 hours after NO inhalation（P〈0.05）.At 52 hours,the concentration reduced to 50% again,no difference was shown between 52 hours and 50 hours（P〈0.05）.When the inhalation stopped at the 54th hour,the mean（37.70 mmHg） bounced but was still lower obviously than that before NO inhalation.Conclusion NO was effective for pulmonary hypertension caused by ARDS.Inhaling NO of 10×10^-6 could make the PAP lower effectively within 24 hours,but it was useless to continue inhaling.

关 键 词：呼吸窘迫综合征 一氧化氮 肺动脉压力 儿童 

分 类 号：R725.63[医药卫生—儿科]