吸入一氧化氮在超早产儿早期难治性低氧性呼吸衰竭中的应用  

The early use of iNO in extremely premature neonates with refractory hypoxic respiratory failure

作　　者：付永萍 陈雪雨 宗海峰 赵捷 唐慧 黄智峰 杨传忠 Fu Yongping;Chen Xueyu;Zong Haifeng;Zhao Jie;Tang Hui;Huang Zhifeng;Yang Chuanzhong(Department of Neonatology,Shenzhen Maternity&Child Healthcare Hospital Affiliated to Southern Medical University,Shenzhen 518028,China)

机构地区：[1]南方医科大学附属深圳妇幼保健院新生儿科,深圳518028

出　　处：《中华新生儿科杂志（中英文）》2023年第3期166-170,共5页Chinese Journal of Neonatology

基　　金：广东省高水平临床重点专科(SZGSP009)。

摘　　要：目的探讨吸入一氧化氮(inhaled nitric oxide,iNO)对超早产儿生后早期难治性低氧性呼吸衰竭(hypoxic respiratory failure,HRF)的治疗效果。方法回顾性选择2021年1-12月南方医科大学附属深圳妇幼保健院新生儿重症监护病房收治的生后1周内应用iNO治疗难治性HRF的超早产儿,分析其临床特征和治疗转归。结果共纳入11例超早产儿,男5例,女6例,中位胎龄24.0(22.6,25.2)周,中位出生体重580(490,770)g。主要伴随疾病为中重度呼吸窘迫综合征(5/11)和早发型败血症(3/11);开始iNO的中位时间为生后6.5(4.5,34.0)h,持续时间中位数24(12,36)h;iNO初始浓度中位数为5(5,8)ppm,治疗浓度范围5~20 ppm。治疗6 h后吸入氧浓度下降超过30%认为治疗有效,8例治疗有效;9例iNO启动1 h、11例在启动12 h氧合指数(oxygenation index,OI)值较基线下降>10%,且OI基线值越高,下降幅度越大。11例患儿中存活8例,死亡1例,放弃2例。结论iNO作为抢救性治疗用于生后早期发生难治性HRF的超早产儿,可以改善其氧合状态,且无明显近期不良结局。Objective To study the early use of inhaled nitric oxide(iNO)as a rescue therapy in extremely premature infants(EPIs)with refractory hypoxic respiratory failure(HRF).Methods Between January 2021 and December 2021,EPIs with refractory HRF receiving iNO within the first week of life in our NICU were enrolled.Their clinical characteristics and outcomes were retrospectively analyzed.Results A total of 11 EPIs were included with 5 males and 6 females.The median gestational age(GA)was 24(22.6,25.2)weeks.The median birth weight(BW)was 580(490,770)g.The most common primary diagnoses were moderate/severe respiratory distress syndrome(RDS)(5/11)and early-onset sepsis(3/11).The median age starting iNO therapy was 6.5(4.5,34.0)h and the median duration of iNO was 24(12,36)h.The median iNO starting dose was 5(5,8)ppm and the therapeutic range was 5-20 ppm.Therapeutic efficacy was defined as≥30%FiO_(2) reduction after 6 h of iNO treatment.The treatment was effective in 8 cases.The oxygenation index(OI)decreased more than 10% from baseline 1 h after initiation in 9 patients and in all 11 patients after 12 h of iNO.The reduction of OI was more prominent in EPIs with a higher OI at baseline.Of the 11 patients,8 survived,1 died and 2 abandoned further treatments.Conclusions As an early rescue therapy for EPIs with refractory HRF,iNO can improve oxygenation without obvious short-term adverse effects.

关 键 词：超早产儿 难治性低氧性呼吸衰竭 吸入一氧化氮 氧合指数 

分 类 号：R722.6[医药卫生—儿科]