NICU吸入一氧化氮治疗严重呼吸窘迫综合征合并持续性肺动脉高压极早产儿的疗效  

Therapeutic effect of NICU inhaled nitric oxide on severe respiratory distress syndrome complicated with persistent pulmonary hypertension of the newborn in very premature infants

作　　者：郝建民 卢涛 邱娟 张鑫 李春红 孟宪英 Hao Jian-min;Lu Tao;Qiu Juan;Zhang Xin;Li Chun-hong;Meng Xian-ying(Department of Obstetrics and Gynecology,Kaifeng Maternal and Child Care Center,Kaifeng 475000,China)

机构地区：[1]开封市妇幼保健院妇产科,河南开封475000 [2]开封市中心医院妇科,河南开封475000 [3]开封市第二人民医院妇产科,河南开封475000

出　　处：《中国急救医学》2019年第12期1169-1175,共7页Chinese Journal of Critical Care Medicine

摘　　要：目的 评价新生儿重症监护病房(NICU)呼吸窘迫综合征(RDS)合并新生儿持续性肺动脉高压(PPHN)极早产儿吸入一氧化氮(INO)的疗效.方法 回顾性分析2018年1月至2019年6月在我院治疗的RDS极早产儿的临床资料.根据患儿是否发生PPHN,将患儿分为PPHN组与非PPHN组,比较PPHN组与非PPHN组患儿的基线临床资料及治疗前,治疗后3、6、12、24、48、72 h的平均气道压(MAP)、氧浓度分数(FiO2)、动脉血氧饱和度/吸入气体氧含量比值(SpO2/FiO2)和氧合指数(OI).根据患儿对INO治疗的反应情况,将患儿分为反应组与未反应组,比较反应组与未反应组患儿的临床资料,采用单变量与多变量Logistic回归分析评价RDS极早产儿INO治疗后反应的独立相关因素.结果 共纳入88例患儿,PPHN发生率为59.1%(52/88).PPHN患儿在INO治疗3h后氧合状况得到显著改善,并一直持续到INO治疗72 h.在治疗后第3、6、12、24、48、72小时,PPHN组FiO2与OI较治疗前显著降低(均P<0.05),SpO2/FiO2较治疗前显著提高(均P<0.05).非PPHN患儿的氧合改善较慢,在INO治疗12 h后才开始改善.多变量Logistic回归分析表明,FiO2 >0.65(HR=6.409,95%CI:1.655~ 24.779,P=0.015),出生体质量> 750 g(HR=4.063,95% CI:1.115~ 14.804,P=0.033)和患有PPHN(HR=9.275,95%CI:1.732 ~49.653,P=0.006)与RDS极早产儿经INO治疗后反应独立相关.结论 PPHN是严重RDS极早产儿的一种常见合并疾病,对于严重RDS极早产儿不推荐使用INO治疗,但对于同时诊断为PPHN的RDS极早产儿则可以考虑进行INO个性化治疗.Objective To evaluate the efficacy of inhaled nitric oxide(INO)in the treatment of respiratory distress syndrome(RDS)and persistent pulmonary hypertension of the newborn(PPHN)in neonatal intensive care unit(NICU).Methods The clinical data of very preterm infants with RDS who were treated in our hospital from January 2018 to June 2019 were retrospectively analyzed.According to whether the patients developed PPHN,the children were divided into PPHN group and non-PPHN group.The baseline clinical data,mean airway pressure(MAP),fraction of inspiration 02(FiO2),oxygen saturation/fraction of inspiration 02(SpO2/FiO2)and oxygenation index(01)were compared between PPHN group and non-PPHN group before treatment and 3,6,12,24,48 and 72 h after treatment.According to the children7 s response to INO treatment,the children were divided into therapeutic response group and therapeutic non-response group,and the clinical data of the children in the response group and the non-response were compared.Univariate and multivariate Logistic regression analysis were used to evaluate independent factors associated with post-treatment response in RDS very preterm infants.Results A total of 88 children were enrolled.The incidence of PPHN was 59.1%(52/88).The oxygenation status of children with PPHN was significantly improved after 3 h of INO treatment,and continued until 72 h after INO treatment.At 3,6,12,24,48 and 72 h after the treatment,FiO2 and 01 in PPHN group were significantly lower than those before treatment(all P<0.05),and SpO2/FiO2 ratio was significantly higher than that before treatment(all P<0.05).The improvement of oxygenation in children with non-PPHN was slower and began to improve after 12 h of INO treatment.Multivariate Logistic regression analysis showed that FiO2>0.65(HR=6.409,95% CI:1.655-24.779,P=0.015),birth weight>750 g(HR=4.063,95% CI:1.115-14.804,P=0.033)and PPHN(HR=9.275,95% CI:732-49.653,P=0.006)were independently associated with very preterm infants of RDS after INO treatment.Conclusion PPHN is a coexisting dis

关 键 词：呼吸窘迫综合征(RDS) 新生儿持续性肺动脉高压(PPHN) 极早产儿 吸入一氧化氮(INO) 

分 类 号：R722.6[医药卫生—儿科]