一氧化氮吸入治疗新生儿持续肺动脉高压  

Inhaled nitric oxide in persistent pulmonary hypertension of newborn

作　　者：孙眉月[1] 杜立中[1] 施丽萍 

机构地区：[1]浙江大学附属儿童医院新生儿监护中心,杭州10003

出　　处：《中华儿科杂志》1999年第12期745-747,共3页Chinese Journal of Pediatrics

摘　　要：目的　探讨吸入一氧化氮(NO)对新生儿持续肺动脉高压(PPHN)的治疗效果。方法　对6 例窒息后PPHN进行NO 吸入治疗,入院后经呼吸机支持,应用NO前呼吸机吸入氧浓度平均为0-93±0-10 ,平均气道压力为(12-7±2-7)cm H2O,入院5～48 小时在呼吸机支持同时加NO 吸入治疗。NO吸入前、后30～60 分钟及12～24 小时动态观察体循环氧合变化,以动脉血氧分压/肺泡氧分压(a/A)及氧合指数(OI)为观察指标,并动态作平均肺动脉血流速度(MPBFV) 、心输出量(CO)、血压及心率的测定。结果　患儿吸入NO5 分钟之后SaO2 明显上升,上升值自11 % ～29% ,30 分钟后a/A比值上升,OI下降,MPBFV 显著上升( P<0-05) ,而CO、心率、血压无变化。12 ～24 小时后氧合持续稳定,治愈4 例,2 例死于严重并发症,吸入NO时NO2 浓度监测均<1×10- 6。结论　NO 吸入能扩张肺血管。Objective To study the theraputic effects of inhaled nitric oxide (iNO) of the newborn infants with persistent pulmonary hypertension (PPHN) Methods Six neonates were mechanically ventilated with FiO 2 of 0 93±0 1 and mean airway pressure (MAP) of 12 7±2 7 cmH 2O Pulmonary hypertension was diagnosed by using Doppler echocardiography Nitric oxide inhalation was given to the patients after conventional ventilation therapy failed Systemic oxygenation, a/A ratio, oxygenation index (OI), mean pulmonary blood flow velocity (MPBFV), cardiac output, blood pressure and heart rate were measured at baseline, 30～60 min and 12～24h after NO therapy Results Significant increase in SaO 2, a/A ratio and decrease in OI were found following 30 min inhalation of 20×10 -6 NO, whereas cardiac output, heart rate, and systemic blood pressure did not change Sustained improvements in oxygenation were noticed at 12～24 h of NO therapy Four neonates survived and 2 died from complications which were not related to NO inhalation Conclusion This preliminary clinical experience suggests that NO may be a selective pulmonary vasodilator and a promising therapy for PPHN. Maintenance of adequate ventilation and cardiac function is important

关 键 词：一氧化氮 吸入法 肺动脉高压 治疗 新生儿 

分 类 号：R725.432[医药卫生—儿科]