NO吸入治疗肺血管适应不良性新生儿持续肺动脉高压的临床疗效  

Clinical Application of NO Inhalation in Treatment of Pulmonary Vascular Maladaptive Persisten Pulmonary Hypertension of the Newborn

作　　者：王小丽 杨艺[2] 黄进洁 陈诚[4] 赵晓莉 吴本清 WANG Xiaoli;YANG Yi;HUANG Jinjie;CHEN Cheng;ZHAO Xiaoli;WU Benqing(Department of Neonatology,Shenzhen Guangming District People′s Hospital,Shenzhen 518106,China;Department of Neonatology,Shenzhen Bao′an Maternal and Child Health Hospital,Shenzhen 518133,China;Department of Neonatology,Shenzhen People′s Hospital,Shenzhen 518020,China;Department of Neonatology,Shenzhen Longgang Maternity and Child Healthcare Hospital,Shenzhen 518172,China;Department of Neonatology,Shenzhen Children′s Hospital,Shenzhen 518034,China)

机构地区：[1]深圳市光明区人民医院新生儿科,广东深圳518106 [2]深圳市宝安区妇幼保健院新生儿科,广东深圳518133 [3]深圳市人民医院新生儿科,广东深圳518020 [4]深圳市龙岗区妇幼保健院新生儿科,广东深圳518172 [5]深圳市儿童医院新生儿科,广东深圳518034

出　　处：《医学综述》2023年第24期5891-5898,共8页Medical Recapitulate

摘　　要：目的探究一氧化氮(NO)吸入治疗肺血管适应不良性新生儿持续肺动脉高压(PPHN)的效果。方法选取2018年1月至2022年12月深圳市新生儿数据协作网所属医院(多中心)新生儿病房收治的68例肺血管适应不良性PPHN患儿为研究对象,根据是否使用NO吸入治疗分为未吸入NO组(38例)和吸入NO组(30例)。未吸入NO组予常规对症支持治疗,吸入NO组在常规对症支持治疗基础上联合低浓度NO吸入治疗。比较两组治疗前与治疗1周左右的血气分析指标,包括动脉血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、血pH值;治疗前后的肺动脉收缩压(PASP)、体循环收缩压(SBP)、左心室射血分数(LVEF)、氧合指数(OI),治疗1周后的疗效,以及不良反应发生情况。结果吸入NO组机械通气时间短于未吸入NO组[6.0(4.0,8.3)d比9.5(7.0,13.0)d](P<0.01)。治疗前,吸入NO组血pH值低于未吸入NO组,PaCO_(2)高于未吸入NO组(P<0.05),余各项血气指标水平比较差异无统计学意义(P>0.05)。治疗1周后,两组SaO_(2)、PaO_(2)、pH值均较治疗前明显升高,PaCO_(2)较治疗前明显降低(P<0.05),且吸入NO组SaO_(2)、PaO_(2)、pH值明显高于未吸入NO组,PaCO_(2)明显低于未吸入NO组(P<0.05)。治疗前,吸入NO组PASP、PASP/SBP高于未吸入NO组(P<0.01),两组SBP比较差异无统计学意义(P>0.05)。治疗1周后,两组PASP、PASP/SBP均较治疗前明显降低,吸入NO组SBP较治疗前升高(P<0.05),且吸入NO组PASP、PASP/SBP明显低于未吸入NO组,SBP水平明显高于未吸入NO组(P<0.05)。治疗前,两组LVEF、OI比较差异无统计学意义(P>0.05)。治疗1周后,两组OI以及吸入NO组LVEF均较治疗前明显升高(P<0.01),且吸入NO组LVEF、OI明显高于未吸入NO组[(0.68±0.06)%比(0.65±0.05)%、280(226,369)mmHg比250(142,280)mmHg](P<0.05)。治疗1周后,吸入NO组治疗总有效率明显高于未吸入NO组[96.67%(29/30)比78.95%(30/38)](χ^(2)=4.584,P=0.032)。吸入NO�Objective To explore the effect of nitric oxide(NO)inhalationin in the treatment of persistent pulmonary hypertension of the newborn(PPHN)with pulmonary vascular maladaptation.Methods A total of 68 children with pulmonary vascular maladaptative PPHN admitted to the hospitals(multiple centers)of neonate data collaboration network of Shenzhen from Jan.2018 to Dec.2022 were included as the study subjects and divided into a NO inhalation group(30 cases)and a non-NO inhalation group(38 cases)based on whether they adopted NO inhalation treatment.The non-NO inhalation group was only treated with conventional supportive treatments,while the NO inhalation group received low concentration NO inhalation therapy in addition to conventional treatment.The blood gas analysis indicators before and around 1 week of treatment,including arterial oxygen saturation(SaO_(2)),arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),and blood pH value;the pulmonary artery systolic pressure(PASP),systemic blood pressure(SBP),left ventricular ejection fraction(LVEF),oxygenation index(OI)before and after treatment;the one week therapeutic effect and total effective rate of the two groups was compared.Results The mechanical ventilation time of the NO inhalation group was shorter than that of the non-NO inhalation group[6.0(4.0,8.3)d vs 9.5(7.0,13.0)d](P<0.01).Before treatment,the blood pH value of the NO inhalation group was lower than that of the non-NO inhalation group,and PaCO_(2) was higher than that of the non-NO inhalation group(P<0.05).There was no statistically significant difference in the levels of other blood gas indicators(P>0.05).After one week of treatment,the SaO_(2),PaO_(2),and pH values of both groups were significantly increased compared to before treatment,while PaCO_(2) was significantly reduced(P<0.05).Moreover,the SaO_(2),PaO_(2) and pH values of the NO inhalation group were significantly higher than those of the non-NO inhalation group,and PaCO_(2) was significantly lower than

关 键 词：新生儿持续肺动脉高压 肺血管适应不良 一氧化氮 机械通气 

分 类 号：R722.1[医药卫生—儿科]