新生儿持续肺动脉高压死亡危险因素分析  

Analysis of risk factors of death in neonates with persistent pulmonary hypertension

作　　者：朱良梅[1] 孔少云[1] 李晓春[1] Zhu Liangmei;Kong Shaoyun;Li Xiaochun(Department of Neonatology,Anqing Municipal Hospital Affiliated to Anhui Medical University,Anqing 246003,China)

机构地区：[1]安徽医科大学附属安庆医院儿科,安庆246003

出　　处：《新医学》2021年第2期137-140,共4页Journal of New Medicine

基　　金：安徽医科大学校临床科研基金(2015xkj147)。

摘　　要：目的探讨新生儿持续肺动脉高压死亡的常见危险因素。方法回顾性分析50例新生儿持续肺动脉高压伴呼吸衰竭患儿的临床资料,50例患儿均需机械通气且均接受了一氧化氮吸入治疗。根据预后将其分为治愈组(38例)和死亡组(12例),收集患儿母亲、患儿的一般资料以及患儿肺动脉压、肺表面活性物质使用情况、呼吸机模式、治疗前后的动脉血气分析及并发气胸等资料,统计分析各因素与患儿死亡的关系。结果死亡组高频呼吸机使用比例低于治愈组(P <0.05)。死亡组合并气胸的比例高于治愈组(P <0.05);死亡组血pH值及PaO2在一氧化氮吸入治疗后低于治愈组(P均<0.05)。多因素Logistic回归分析提示,机械通气联合一氧化氮吸入治疗后动脉血PaO2值为影响新生儿持续肺动脉高压预后的独立危险因素(OR=0.715,95%CI0.525~0.973,P <0.05)。结论尽早使用高频呼吸机并联合一氧化氮吸入治疗,及时纠正低氧血症,维持正常动脉血PaO2可提高新生儿持续肺动脉高压的救治成功率,改善患儿预后。Objective To explore the risk factors of death in neonates diagnosed with persistent pulmonary hypertension. Methods Clinical data of 50 neonates with persistent pulmonary hypertension complicated with respiratory failure were retrospectively analyzed. All neonates received mechanical oscillatory ventilation combined with nitric oxide(NO) inhalation. According to clinical prognosis, they were divided into the healing group(n = 38) and death group(n = 12). The general data of mothers and neonates, pulmonary artery pressure, pulmonary surfactant use, ventilator mode, arterial blood gas analysis before and after treatment and pneumothorax were collected. The relationship between various factors and neonatal death was statistically analyzed. Results The proportion of high-frequency oscillatory ventilator use in the death group was significantly lower than that in the healing group(P < 0.05). The proportion of pneumothorax in the death group was remarkably higher than that in the healing group(P < 0.05). After NO inhalation treatment, the pH value and PaO2 in the death group were significantly lower than those in the healing group(both P < 0.05). Multivariate Logistic regression analysis showed that PaO2 value of the arterial blood was an independent risk factor for clinical prognosis after mechanical oscillatory ventilation combined with NO treatment(OR = 0.715, 95%CI 0.525-0.973, P < 0.05). Conclusions Early use of high-frequency oscillatory ventilation combined with NO inhalation, timely management of hypoxemia and maintenance of normal arterial blood PaO2 can improve the success rate of treatment and improve the clinical prognosis of the affected neonates.

关 键 词：机械通气 高频振荡通气 一氧化氮吸入 新生儿持续性肺动脉高压 低氧血症 预后 

分 类 号：R722.1[医药卫生—儿科]