摘要
目的探讨常频机械通气联合一氧化氮吸入（iNO）治疗新生儿持续肺动脉高压（PPHN）的疗效。方法对33例确诊为PPHN且入院时采取常频机械通气疗效不满意的患儿给予iNO。NO初始吸入浓度20例为10ppm,13例为15-25 ppm。当SpO2≥90%并已经稳定30 min以上,开始下调呼吸机参数,并逐渐下调iNO吸入浓度。当iNO吸入浓度降至5 ppm时,再持续2-3 h,若PaO2〉55 mmHg（1 mmHg=0.133 kPa）、SpO2〉90%时停止吸入。在NO吸入前和吸入后2-6 h分别进行血气分析,连续记录生命体征、SpO2等。结果 28例在吸入NO后30 min左右SpO2逐渐升高,临床缺氧状态逐步改善,有效率达84.85%。吸入NO 2-6 h,SpO2、PaO2分别由吸入前的（70.5±14.1）%、（45.8±10.7）mm Hg升到（94.6±2.7）%和（92.9±24.6）mmHg,FiO2由0.90±0.10降至0.60±0.08,差异均有统计学意义（P〈0.05）。患儿生命体征平稳,未发现急性合并症。全组治愈28例,治愈率为达（84.85%）,自动放弃3例,死亡2例。结论 iNO能有效地解除PPHN患儿的肺血管痉挛,提高血氧分压和治愈率。iNO吸入不良反应小、易操作,值得推广。
Objective To evaluate the effects of inhaled nitric oxide（ iNO） therapy combined with conventional ventilation on persistent pulmonary hypertension of the newborn（ PPHN）. Methods NO inspiration was performed in 33 infants with PPHN who were not responsive to the conventional ventilation. The iNO concentration started at 10 ppm for 20 infants and（ 15-25） ppm for 13 infants. When SpO2≥90% and remain stable for 30 min,the parameters of ventilator were regulated down,and gradually regulated down the iNO concentration. When iNO concentration reached 5 ppm,ventilation was lasted for 2 to 3 hours. The ventilation was stopped when PaO2 〉55 mm Hg and SpO2 〉90%. The blood gas analysis,SpO2 and vital signs were monitored before and 2 to 6 hours after the administration of iNO. Results Clinical situation were significantly improved in 28（ 84. 85%） of the infants with SpO2 gradually going up after 30 minutes of iN0. Before iNO,mean FiO2was（ 0. 90 ± 0. 10）,SpO2was（ 70. 5 ± 14. 1） %,and PaO2was（ 45. 8 ± 10. 7） mm Hg. From 2 to 6hours after iNO,SpO2 increased to（ 95. 3 ± 3. 6） %,PaO2 increased to（ 92. 9 ± 24. 6） mmHg,FiO2 decreased to（ 0.60 ±0.08）. The differences were significant（ P〈0. 05）.28 of 33（ 84.85%） infants survived. Conclusion The iNO is effective in reliving vasospasm of pulmonary vasculature in infants with PPHN and improving partial pressure of blood oxygen and cure rate. There are no remarkable side effects. It is easy to operating and worthy of promotion.
出处
《中华全科医学》
2014年第9期1417-1418,1421,共3页
Chinese Journal of General Practice
关键词
一氧化氮
吸入治疗
持续肺动脉高压
常频机械通气
婴儿
新生
Nitric oxide
Inhalation treatment
Persistent pulmonary hypertension of the newborn
Conventional mechanical ventilation
