目的：观察一氧化氮吸入(inhaled nitric oxide,iNO)联合西地那非口服治疗新生儿持续性肺动脉高压的疗效。方法46例持续性肺动脉高压的新生儿在高频通气、扩容、稳定血压、镇静等常规治疗基础上分别采用 iNO 联合西地那非口服组(n ﹦23)和单独 iNO 组(n ﹦23)治疗,治疗有效的患儿监测血气指标、体循环收缩压(systolic blood pressure,SBP)、肺动脉收缩压(systolic pulmonary arter-y pressure,SPAP)、吸入氧浓度(inspired oxygen fraction,FiO2),计算 SPAP/SBP,PaO2/FiO2,并记录初始iNO 浓度、iNO 持续时间、机械通气时间、住院时间,比较两组疗效,包括病死率,气漏、颅内出血、支气管肺部发育不良、肺出血的发生率。结果 iNO 联合西地那非口服组有效20例,有效率87.0%(20/23),单独 iNO 治疗组有效18例,有效率78.3%(18/23),两组疗效比较差异无统计学意义(χ2﹦0.15, P ﹦0.700)。两组在治疗后30 min、6 h、治疗结束时 SPAP、SPAP /SBP 均明显下降,PaO2/FiO2显著上升,而两组间比较差异无统计学意义(P 〉0.05)。iNO 联合西地那非口服组初始 iNO 浓度≥15×10－614例,〉15×10－66例；单独 iNO 治疗组初始 iNO 浓度≥15×10－66例,〉15×10－612例,iNO 联合西地那非口服组初始 iNO 浓度低于单独 iNO 治疗组,差异有统计学意义(P 〈0.05)。iNO 联合西地那非口服组 iNO 持续时间(57.3±27.8)h,机械通气时间(94.44±31.88)h,住院时间(14.55±3.19)d,单独iNO 治疗组 iNO 持续时间(87.7±47.0)h,机械通气时间(123.20±47.43)h,住院时间(18.78±4.60) d,iNO 联合西地那非口服组 iNO 持续时间、机械通气时间、住院时间均低于单独 iNO 治疗组,差异有统计学意义(P 〈0.05),而病死率,气漏、颅内出血、支气管肺部发育不良、肺出血的发生率差异无统计学意义(P 〉0.05)。结论对比单独应用 iNO,iNO 联合西地那非口服对降低肺动脉高压疗效无明显差异性,但能有效降低初始 iNO 浓度,缩短 iNO 持续时间、机械通气时间及住院时间,并未增加主要并发症的发生。
目的：觀察一氧化氮吸入(inhaled nitric oxide,iNO)聯閤西地那非口服治療新生兒持續性肺動脈高壓的療效。方法46例持續性肺動脈高壓的新生兒在高頻通氣、擴容、穩定血壓、鎮靜等常規治療基礎上分彆採用 iNO 聯閤西地那非口服組(n ﹦23)和單獨 iNO 組(n ﹦23)治療,治療有效的患兒鑑測血氣指標、體循環收縮壓(systolic blood pressure,SBP)、肺動脈收縮壓(systolic pulmonary arter-y pressure,SPAP)、吸入氧濃度(inspired oxygen fraction,FiO2),計算 SPAP/SBP,PaO2/FiO2,併記錄初始iNO 濃度、iNO 持續時間、機械通氣時間、住院時間,比較兩組療效,包括病死率,氣漏、顱內齣血、支氣管肺部髮育不良、肺齣血的髮生率。結果 iNO 聯閤西地那非口服組有效20例,有效率87.0%(20/23),單獨 iNO 治療組有效18例,有效率78.3%(18/23),兩組療效比較差異無統計學意義(χ2﹦0.15, P ﹦0.700)。兩組在治療後30 min、6 h、治療結束時 SPAP、SPAP /SBP 均明顯下降,PaO2/FiO2顯著上升,而兩組間比較差異無統計學意義(P 〉0.05)。iNO 聯閤西地那非口服組初始 iNO 濃度≥15×10－614例,〉15×10－66例；單獨 iNO 治療組初始 iNO 濃度≥15×10－66例,〉15×10－612例,iNO 聯閤西地那非口服組初始 iNO 濃度低于單獨 iNO 治療組,差異有統計學意義(P 〈0.05)。iNO 聯閤西地那非口服組 iNO 持續時間(57.3±27.8)h,機械通氣時間(94.44±31.88)h,住院時間(14.55±3.19)d,單獨iNO 治療組 iNO 持續時間(87.7±47.0)h,機械通氣時間(123.20±47.43)h,住院時間(18.78±4.60) d,iNO 聯閤西地那非口服組 iNO 持續時間、機械通氣時間、住院時間均低于單獨 iNO 治療組,差異有統計學意義(P 〈0.05),而病死率,氣漏、顱內齣血、支氣管肺部髮育不良、肺齣血的髮生率差異無統計學意義(P 〉0.05)。結論對比單獨應用 iNO,iNO 聯閤西地那非口服對降低肺動脈高壓療效無明顯差異性,但能有效降低初始 iNO 濃度,縮短 iNO 持續時間、機械通氣時間及住院時間,併未增加主要併髮癥的髮生。
목적：관찰일양화담흡입(inhaled nitric oxide,iNO)연합서지나비구복치료신생인지속성폐동맥고압적료효。방법46례지속성폐동맥고압적신생인재고빈통기、확용、은정혈압、진정등상규치료기출상분별채용 iNO 연합서지나비구복조(n ﹦23)화단독 iNO 조(n ﹦23)치료,치료유효적환인감측혈기지표、체순배수축압(systolic blood pressure,SBP)、폐동맥수축압(systolic pulmonary arter-y pressure,SPAP)、흡입양농도(inspired oxygen fraction,FiO2),계산 SPAP/SBP,PaO2/FiO2,병기록초시iNO 농도、iNO 지속시간、궤계통기시간、주원시간,비교량조료효,포괄병사솔,기루、로내출혈、지기관폐부발육불량、폐출혈적발생솔。결과 iNO 연합서지나비구복조유효20례,유효솔87.0%(20/23),단독 iNO 치료조유효18례,유효솔78.3%(18/23),량조료효비교차이무통계학의의(χ2﹦0.15, P ﹦0.700)。량조재치료후30 min、6 h、치료결속시 SPAP、SPAP /SBP 균명현하강,PaO2/FiO2현저상승,이량조간비교차이무통계학의의(P 〉0.05)。iNO 연합서지나비구복조초시 iNO 농도≥15×10－614례,〉15×10－66례；단독 iNO 치료조초시 iNO 농도≥15×10－66례,〉15×10－612례,iNO 연합서지나비구복조초시 iNO 농도저우단독 iNO 치료조,차이유통계학의의(P 〈0.05)。iNO 연합서지나비구복조 iNO 지속시간(57.3±27.8)h,궤계통기시간(94.44±31.88)h,주원시간(14.55±3.19)d,단독iNO 치료조 iNO 지속시간(87.7±47.0)h,궤계통기시간(123.20±47.43)h,주원시간(18.78±4.60) d,iNO 연합서지나비구복조 iNO 지속시간、궤계통기시간、주원시간균저우단독 iNO 치료조,차이유통계학의의(P 〈0.05),이병사솔,기루、로내출혈、지기관폐부발육불량、폐출혈적발생솔차이무통계학의의(P 〉0.05)。결론대비단독응용 iNO,iNO 연합서지나비구복대강저폐동맥고압료효무명현차이성,단능유효강저초시 iNO 농도,축단 iNO 지속시간、궤계통기시간급주원시간,병미증가주요병발증적발생。
Objective To evaluate the effects of inhaled nitric oxide(iNO)combined with oral sil-denafil therapy in the newborn infants with persistent pulmonary hypertension(PPHN).Methods Forty-six neonates with PPHN were devided into group A(n ﹦23)and group B(n ﹦23).The combined treatment of iNO and oral sildenafil was used in group A,and iNO was used in group B.During the therapy,the following factors were monitored:blood gas analysis,systolic blood pressure(SBP),systolic pulmonary artery pressure (SPAP),inspired oxygen fraction (FiO2 ),iNO concentration,iNO duration,ventilation time and hospital stay.The effective rate,mortality and the risk of pneumothorax,intraventricular hemorrhage,pulmonary hem-orrhage,bronchopulmonary dysplasia were compared between the two groups.All patients were treated in the same neonatal unit and received the same standard therapy throughout the study period.Results The effec-tive rates of group A and group B were 87.0%(20 /23)and 78.3%(18 /23)respectively.There was no sig-nificant difference between the two groups(χ2 ﹦0.15,P 〉0.05).The levels of SPAP/SBP decreased signifi-cantly,and the levels of PaO2 /FiO2 rised significantly at baseline 30 min,6 h and after the treatment.But there were no significant differences between the two groups(P 〉0.05).In group A,the iNO concentration stared at ≥15 ×10 -6 for 14 infants,〉15 ×10 -6 for 6 infants,which were lower than those in the group B (χ2 ﹦6.71 ,P 〈0.05).The iNO would be stopped when the concentration reached 40 ×10 -6 without any sign of improvement.Compared to group B,the duration of iNO[(57.3 ±27.8)h vs.(87.7 ±47.0)h],the ven-tilation time[(94.44 ±31 .88)h vs.(123.20 ±47.43)h],and the time of hospital stay[(14.55 ±3.19)d vs.(18.78 ±4.60)d]in group A were shorter(P 〈0.05),whereas the mortality and the incidence of pneu-mothorax,intraventricular hemorrhage,pulmonary hemorrhage and bronchopulmonary dysplasia had not sig-nificantly differences between the two groups.Conclusion The effects of iNO combined with oral sildenafil in the newborn infants with PPHN was same compared to iNO.But it can effectively reduced the iNO concen-tration and shorten the duration of iNO,the ventilation time and the hospital stay without augmentation of risk of mortality,pneumothorax,intraventricular hemorrhage,pulmonary hemorrhage,bronchopulmonary dysplasia in neonatal patients.
