iNO联合HFOV在新生儿肺动脉高压中的应用及其对血清胱抑素C、骨保护素、BNP水平的影响  

Application of iNO combined with HFOV in neonates with pulmonary hypertension and its effect on serum cystatin C,osteoprotegerin and BNP levels

作　　者：张冉 高月荣 刘欣 张苗苗 冀京雷 范雪爱 Zhang Ran;Gao Yuerong;Liu Xin;Zhang Miaomiao;Ji Jinglei;Fan Xueai(Xingtai Third Hospital,Xingtai 054000,China)

机构地区：[1]邢台市第三医院,邢台054000

出　　处：《分析仪器》2022年第5期73-79,共7页Analytical Instrumentation

基　　金：邢台市科技计划项目:一氧化氮吸入联合高频振荡通气对新生儿肺动脉高压疗效的临床研究,课题编号:2019ZC179。

摘　　要：目的:探讨吸入一氧化氮(inhaled nitric oxide)联合高频振荡通气(High-frequency Oscillation Ventilation,HFOV)在新生儿肺动脉高压中的应用及其对血清胱抑素C、骨保护素、B型钠尿肽(B type natriuretic peptide,BNP)水平的影响。方法:选择2018年10月至2021年1月本院收治的162例肺动脉高压患儿,男性89例,女性73例,均经超声心动图确诊为持续肺动脉高压,根据随机数表法随机将患儿分成对照组和观察组,对照组行HFOV,而观察组患儿行iNO联合HFOV,对比两组患儿氧疗时间、呼吸机使用时间和住院天数等治疗情况、血气分析指标、血清胱抑素C、骨保护素、BNP及转归等参数。结果:观察组患者氧疗时间(8.49±0.89 vs 14.21±2.09,t=22.662,P=0.000)、呼吸机使用时间(5.09±0.65 vs 8.25±0.59,t=32.398,P=0.000)和住院天数(18.81±2.98 vs23.16±3.94,t=7.925,P=0.000)明显低于对照组。观察组患者PaO(77.92±4.02 vs 70.01±3.88,t=12.742,P=0.000)和SaO_(2)(97.34±4.31 vs 85.34±4.87,t=16.607,P=0.000)明显高于对照组,观察组患者PaCO_(2)(36.78±3.89 vs 44.03±3.91,t=11.830,P=0.000)和PAP(15.28±3.02 vs 24.09±3.12,t=18.260,P=0.000)明显低于对照组。观察组患者血清胱抑素C(0.75±0.10 vs 0.98±0.15,t=11.482,P=0.000)、骨保护素(117.54±23.89 vs 147.32±22.91,t=8.097,P=0.794)和BNP(0.59±0.18 vs 0.89±0.27,t=8.321,P=0.000)明显低于对照组。观察组患者出院死亡(χ^(2)=2.104,P=0.147)、低血压(χ^(2)=1.267,P=0.260)及PAP反弹发生率(χ^(2)=0.426,P=0.514)低于对照组,但差异未见显著性。结论:iNO联合HFOV应用于新生儿肺动脉高压,可有效缩短治疗时间,改善血气分析指标,降低胱抑素C、骨保护素和BNP水平,安全有效,值得临床进一步研究并推广。162 children with pulmonary hypertension admitted to Xingtai third hospital from October 2018to January 2021,including 89 males and 73 females,were randomly divided into control group and observation group according to random number table method.The control group was treated with HFOV,while the observation group was treated with iNO combined with HFOV.The two groups were compared in terms of oxygen therapy duration,ventilator duration,hospitalization days,blood gas analysis indexes,serum cystatin C,osteoprotegerin,BNP and outcome.The results showed that oxygen therapy time(8.49±0.89 vs 14.21±2.09,t=22.662,P=0.000),ventilator use time(5.09±0.65 vs 8.25±0.59,t=32.398,P=0.000)and hospitalization days(18.81±2.98 vs 23.16±3.94,t=7.925,P=0.000)of the observation group were significantly lower than those of the control group;PaO(77.92±4.02 vs 70.01±3.88,t=12.742,P=0.000)and SaO_(2)(97.34±4.31 vs 85.34±4.87,t=16.607,P=0.000)of the observation group were significantly higher than those of the control group.PaCO_(2)(36.78±3.89 vs 44.03±3.91,t=11.830,P=0.000)and PAP(15.28±3.02 vs 24.09±3.12,t=18.260,P=0.000)of the observation group were significantly lower than those of the control group.Serum cystatin C(0.75±0.10 vs 0.98±0.15,t=11.482,P=0.000),osteoprotegerin(117.54±23.89 vs 147.32±22.91,t=8.097,P=0.794)and BNP(0.59±0.18 vs 0.89±0.27,t=8.321,P=0.000)of the observation group were significantly lower than those of the control group.The incidence of discharge death(χ~2=2.104,P=0.147),hypotension(χ~2=1.267,P=0.260)and PAP rebound(χ~2=0.426,P=0.514)of the observation group were lower than those of the control group,but the difference was not significant.This method can effectively shorten the treatment time,improve blood gas analysis indicators,and reduce the levels of cystatin C,osteoprotegerin and BNP.

关 键 词：吸入一氧化氮 高频震荡通气 肺动脉高压 临床疗效 胱抑素C 骨保护素 B型钠尿肽 

分 类 号：R722.1[医药卫生—儿科]