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目的探讨吸入一氧化氮治疗新生儿低氧性呼吸衰竭的短期临床疗效及安全性。方法选择2010年3月至2013年9月我院新生儿重症监护病房收治、进行常频机械通气的低氧性呼吸衰竭新生儿,随机分为观察组和对照组,以常频通气Fi O2≥60%、PIP≥24 cm H2O为观察点,观察组患儿联合吸入一氧化氮(起始浓度15 ppm,最大浓度20 ppm),观察两组患儿吸入氧浓度、氧合指数、动脉血氧分压/吸入氧浓度比值、肺动脉压力、平均气道压力、心率、平均动脉压、肝肾功能、血小板等指标变化,以及气胸、颅内出血等并发症发生率。结果共纳入32例,观察组19例,对照组13例。吸入氧浓度及氧合指数:观察组吸入一氧化氮1 h开始明显下降(P<0.001),对照组在观察12 h后开始下降,且无观察组显著(P<0.01);动脉血氧分压/吸入氧浓度比值:两组均呈上升趋势,1 h已较治疗前明显升高,观察组差异有统计学意义(P<0.001),并持续至72 h,对照组无观察组改善显著(P<0.01)。平均气道压力:观察组吸入一氧化氮12 h开始下降(P<0.01),对照组无明显变化(P>0.01);肺动脉压力:两组治疗后均下降,观察组(25.2±4.4)mm Hg较对照组(35.9±3.1)mm Hg明显,组间比较差异有统计学意义(P<0.001);血小板:两组均呈下降趋势,观察组下降较对照组明显(P<0.01),临床未见明显出血倾向,并于72 h后恢复正常。两组心率、平均动脉压、肝肾功能、病死率及气胸、颅内出血、支气管肺发育不良等并发症发生率差异均无统计学意义(P>0.01),观察组出现2例一过性心律失常,1例肾衰竭放弃治疗失访。结论吸入一氧化氮治疗新生儿低氧性呼吸衰竭具有理想的改善氧合的效果,短期无明显不良反应。
Objective To investigate the short-term clinical efficacy and safety of inhaled nitric oxide in the treatment of neonatal hypoxic respiratory failure. Methods From March 2010 to September 2013, neonatal intensive care unit of our hospital was treated, and neonates with hypoxemic respiratory failure undergoing constant-frequency mechanical ventilation were randomly divided into observation group and control group. 60% and PIP≥24 cm H2O were used as the observation points. The children in the observation group received inhaled nitric oxide (initial concentration of 15 ppm and maximum concentration of 20 ppm). The levels of inspired oxygen, oxygenation index, arterial oxygenation Partial pressure / inhaled oxygen concentration ratio, pulmonary artery pressure, mean airway pressure, heart rate, mean arterial pressure, liver and kidney function, platelet and other indicators, and the incidence of complications such as pneumothorax and intracranial hemorrhage. Results A total of 32 cases were included, 19 cases in the observation group and 13 cases in the control group. Inhaled oxygen concentration and oxygenation index: In the observation group, nitric oxide (NO) started to decrease obviously at 1 hour (P <0.001), while the control group began to decrease 12 hours after observation, and there was no significant difference in the observation group (P <0.01) Pressure / inhaled oxygen concentration ratio: both groups showed an upward trend, 1 h was significantly higher than before treatment, the observation group difference was statistically significant (P <0.001), and continued until 72 h, the control group no significant improvement (P <0.01). The average airway pressure: The level of nitric oxide inhaled in the observation group began to decrease at 12 h (P <0.01), but there was no significant change in the control group (P> 0.01). The pulmonary artery pressure decreased in both groups after treatment. The observation group (25.2 ± 4.4) mm Hg was significantly higher than that of the control group (35.9 ± 3.1) mm Hg, the difference was statistically significant (P <0.001); platelet: both groups showed a decreasing trend, the observation group decreased significantly compared with the control group (P <0.01) No obvious bleeding tendency, and returned to normal after 72 h. There were no significant differences in the incidence of complications such as heart rate, mean arterial pressure, liver and kidney function, fatality rate and pneumothorax, intracranial hemorrhage and bronchopulmonary dysplasia (P> 0.01). Two cases of transient heart rhythm Abnormal, 1 case of renal failure to give up treatment lost. Conclusion Inhalation of nitric oxide to treat neonatal hypoxic respiratory failure has the ideal effect of improving oxygenation, and there is no obvious adverse reaction in short term.