吸入一氧化氮联合高频震荡通气治疗新生儿严重低氧血症的预后  

Prognosis of inhaled nitric oxide associated with high-frequency oscillatory ventilation treatment in neonates with severe hypoxemia

作　　者：康文清[1] 孙慧清[1] 陈宇辉[1] 许邦礼[1] 刘大鹏[1] 金娟[1] 郭静[1] 熊虹[1] 

机构地区：[1]郑州市儿童医院NICU,450053

出　　处：《中华实用儿科临床杂志》2013年第18期1402-1404,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的 分析吸入一氧化氮（N0）联合高频震荡通气（HFOV）治疗新生儿严重低氧血症的预后.方法 符合入选标准的98例新生儿纳入研究：对照组48例,由常频机械通气改为HFOV;治疗组50例,改为NO吸入联合HFOV.2组均按照原发病予常规治疗.观察2组患儿28 d病死率、机械通气时间、氧疗时间、气漏（气胸和肺间质气肿）、肺出血、坏死性小肠结肠炎（NEC）、严重颅内出血（IVH）的发生率.出院后进行随访,评价18个月时2组患儿的预后.结果 1.治疗组死亡4例（8.0％）,对照组死亡11例（22.9％）,2组病死率比较差异有统计学意义（t =4.20,P＜0.05）.2.治疗组患儿机械通气时间及氧疗时间明显短于对照组,差异有统计学意义（t=2.42,P＜0.05;t =4.63,P＜0.001）.但2组患儿气漏、肺出血、NEC及严重IVH发生率比较差异均无统计学意义.3.随访18个月,2组患儿脑性瘫痪,听力、视力损害和严重神经损害的发生率差异均无统计学意义,智能发育指数和运动发育指数相近.结论 在没有体外膜肺的情况下,吸入NO联合HFOV能明显降低严重低氧血症新生儿的病死率,显著缩短机械通气时间和氧疗时间,不影响18个月时的神经发育.Objective To analyze the prognosis of severe hypoxemia treated with inhaled nitric oxide （iNO） plus high-frequency oscillatory ventilation （HFOV） in neonates.Methods Neonates （98 cases） in accordance with the criteria were divided into the treatment group （n =50） and the control group（n =48）.The patients of the control group switched conventional mechanical ventilation to HOFV,and the patients of the treatment group were given iNO plus HFOV.The death rate in 28 days,time of mechanical ventilation and supplemental oxygen,and the incidence of pulmonary airleak,pulmonary haemorrhage,necrotizing enterocolitis （NEC） and severe intraventricular hae-morrhage （IVH） were observed.At 18 months of age,the comprehensive neurodevelopmental conditions of survivors were assessed.Results 1.There was a significant difference in the death rate between the 2 groups （8.0％ vs 22.9％,t =4.20,P ＜ 0.05）.2.The time of mechanical ventilation and supplemental oxygen of treatment group were significantly shorter than those in control group （t =2.42,P ＜ 0.05 ; t =4.63,P ＜ 0.001）.But the incidence of pulmonary airleak,pulmonary haemorrhage,NEC and severe IVH between the 2 groups were similar.3.At 18 months of age,there was no significant difference between the 2 groups in the incidence of cerebral palsy,hearing,vision and the neurodevelopmental impairments.Mental developmental index scores and psychomotor developmental index scores were similar between the 2 groups.Conclusions Without extracorporeal membrane oxygenation,iNO with HFOV can significantly decrease the death rate,reduce the time of mechanical ventilation and supplemental oxygen for neonates with severe hypoxemia,without adverse effect on neurodevelopment at 18 months of age.

关 键 词：预后 吸入一氧化氮 高频震荡通气 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]