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目的探讨一氧化氮吸入(i NO)联合高频振荡通气(HFOV)治疗新生儿持续肺动脉高压(PPHN)的临床疗效。方法回顾性分析2010年1月至2013年12月本院新生儿重症监护病房收治的PPHN患儿临床资料,根据不同时间段治疗措施不同分为HFOV组、常频机械通气(CMV)+i NO组、HFOV+i NO组。记录并比较各组患儿治疗前、治疗2、12、24 h的吸入氧浓度(Fi O2)、氧合指数(OI)、肺动脉压力,以及呼吸机使用情况、住院时间、症状变化及转归。结果治疗2、12、24 h,HFOV+i NO组Fi O2、OI、肺动脉压力均低于CMV+i NO组和HFOV组,CMV+i NO组低于HFOV组[2 h Fi O2:(0.43±0.15)比(0.58±0.11)、(0.71±0.13),OI:(17.1±5.6)mm Hg比(20.3±6.2)mm Hg、(22.6±6.4)mm Hg,肺动脉压力:(46.2±4.6)mm Hg比(51.3±4.4)mm Hg、(58.3±3.7)mm Hg;24h Fi O2:(0.26±0.14)比(0.32±0.16)、(0.42±0.13),OI:(8.4±4.2)mm Hg比(11.6±4.6)mm Hg、(13.8±3.8)mm Hg,肺动脉压力:(15.3±4.4)mm Hg比(24.5±4.5)mm Hg、(35.6±3.6)mm Hg,P<0.05]。HFOV+i NO组机械通气时间、氧疗时间及住院时间均短于CMV+i NO组和HFOV组,CMV+i NO组短于HFOV组,差异有统计学意义(P<0.05);各组患儿病死率及Ⅲ度以上颅内出血发生率差异无统计学意义(P>0.05)。结论早期i NO联合HFOV治疗PPHN疗效显著,能迅速改善肺动脉高压患儿的氧合情况,显著缩短患儿的上机时间、氧暴露时间及住院时间,但对患儿病死率及Ⅲ度以上颅内出血发生率没有影响。
Objective To investigate the clinical efficacy of nitric oxide inhalation (iNO) combined with high frequency oscillatory ventilation (HFOV) in the treatment of neonatal persistent pulmonary hypertension (PPHN). Methods The clinical data of PPHN children admitted to our neonatal intensive care unit from January 2010 to December 2013 were retrospectively analyzed. According to the different treatment measures, the patients were divided into HFOV group, CMV + i NO Group, HFOV + i NO group. The oxygen intake (Fi O2), oxygenation index (OI), pulmonary artery pressure, ventilator usage, hospitalization duration, symptom changes and outcome of 2,12,24 h before treatment were recorded and compared in each group . Results At 2, 12 and 24 h, FiO2, OI and pulmonary artery pressure in HFOV + i NO group were lower than those in CMV + i NO group and HFOV group, while those in HFV + i NO group were lower than those in HFOV group [2 h Fi O2: (0.43 (P <0.05), and the mean arterial blood pressure (P <0.01) was significantly higher than that of the control group (0.58 ± 0.11), (0.71 ± 0.13), and OI: (17.1 ± 5.6) mm Hg (20.3 ± 6.2) mm Hg mm Hg was (51.3 ± 4.4) mm Hg, (58.3 ± 3.7) mm Hg, 24h Fi O2 was (0.26 ± 0.14) vs (0.42 ± 0.13), OI was (8.4 ± 4.2) mm Hg (11.6 ± 4.6) mm Hg, (13.8 ± 3.8) mm Hg, pulmonary artery pressure (15.3 ± 4.4) mm Hg, (24.5 ± 4.5) mm Hg and (35.6 ± 3.6) mm Hg, respectively. The duration of mechanical ventilation, oxygen therapy and hospital stay in HFOV + i NO group were shorter than that in CMV + i NO group and HFOV group, but shorter in CMV + i NO group than in HFOV group (P <0.05) No significant difference was found in the incidence of intracranial hemorrhage between the third degree and the third degree in children (P> 0.05). Conclusions Early treatment of PPHN with iNO combined with HFOV has significant curative effect. It can rapidly improve oxygenation in children with pulmonary hypertension and shorten the time of on-boarding, oxygen exposure and hospital stay significantly. However, The incidence of internal bleeding had no effect.