一氧化氮治疗新生儿持续肺动脉高压42例疗效观察  

Effect of inhaled nitric oxide in 42 children with neonatal persistent pulmonary hypertension

作　　者：陈运彬[1] 高薇薇[1] 

机构地区：[1]广东省妇幼保健院,广州510010

出　　处：《中国实用儿科杂志》2003年第7期411-413,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的　探讨一氧化氮 (NO)吸入疗法治疗新生儿持续肺动脉高压 (PPHN)的疗效。方法　对 4 2例新生儿PPHN和呼吸衰竭患儿按解剖性血管梗阻和肺血管痉挛分为Ⅰ组和Ⅱ组 ,分别在呼吸机机械通气情况下 ,将NO气源加入呼吸机环路中 ,NO质量浓度从 2 0× 10 -6mg/L(2 0 ppm)开始 ,每经 15～ 30min无效者增加 (5～10 )× 10 -6mg/L(5～ 10 ppm) ,达到 4 0× 10 -6mg/L仍无效者停用。有效者经予吸入较高浓度NO 6h后 ,每 30min降低NO质量浓度 (5～ 10 )× 10 -6mg/L ,如患儿的PaO2 下降不超过 15 % ,可降至 6× 10 -6mg/L后维持 36～ 72h ,治疗时观察全身氧合情况的变化 ,监测心率、血压、吸入前后血高铁血红蛋白 (MHb)定量及凝血功能。结果　Ⅱ组 33例患儿中 2 7例 (81 82 % )治疗后氧合情况显著改善 ;Ⅰ组治疗后氧合情况无改善。两组心率、血压、凝血功能无明显改变 ,MHb定量的改变无临床意义。结论　低浓度短期NO吸入疗法治疗肺血管痉挛所致持续肺动脉高压有显著疗效 ,且未见明显副作用 ,但对解剖性血管梗阻所致持续肺动脉高压疗效欠佳。Objective To discuss the effect of inhaled nitric oxide (iNO) therapy in neonatal persistent pulmonary hypertension(PPHN).Methods 42 neonates with PPHN and respiratory failure (RF) were classified as group Ⅰ and group Ⅱ according to anatomic vascular obstruction and pulmonary angiospasm.During mechanical ventilation,NO was added into ventilator circle,the NO concentration began at 20×10 -6mg/L and was increased by (5～10)×10 -6mg/L every 15～30 minutes in cases who showed no improvement.The treatment would be stopped if the NO concentration arrived 40×10 -6mg/L but still with no effect.The relieved patients inhaled high concentration NO for 6 hours and then NO concentration was decreased by (5～10)×10 -6mg/L every 30 minutes.If the patient's PaO 2 decreased by no more than 15%,the NO concentration could be maintained at 6×10 -6mg/L for 36～72 hours.Oxygenation,heart rate,blood pressure,methemoglobin and coagulation function were monitored before and after treatment.Results Among the 33 newborns in group Ⅱ,the oxygenation were improved in 27 cases(81.82%).In group Ⅰ,there were no significant changes.No significant changes were found in heart rate,blood pressure,coagulation function and methemoglobin.Conclusion There is distinct effect in short-term inhaling low concentration NO in PPHN developed from pulmonary angiospam.There are no remarkable side effects.There are no curative effects in PPHN induced by vascular obstruction.

关 键 词：持续肺动脉高压 一氧化氮 治疗 新生儿 疗效观察 呼吸衰竭 呼吸衰竭 呼吸机 机械通气 诊断 

分 类 号：R722[医药卫生—儿科] R725.432[医药卫生—临床医学]