CAJ | 학술논문

目的探讨吸入一氧化氮( inhaled nitric oxide,iNO)联合高频震荡通气并西地那非口服对难治性新生儿持续肺动脉高压( PPHN)的作用. 方法收集2012年1月至2014年1月咸阳市儿童医院新生儿重症病房收治的经常频通气加iNO无效的难治性新生儿持续性肺动脉高压患儿13例,对受试患儿经予高频震荡通气及iNO治疗. 比较受试对象治疗前后氧分压( PaO2 )、二氧化碳分压( PaCO2 )、血氧饱和度( SaO2 )、吸入氧浓度( FiO2 )、肺动脉压、平均压、氧合指数等的变化. 结果在治疗2h后, PaCO2 未见显著变化(t=0.89,P>0.05),而PaO2 干预前后存在显著统计学差异(t=4.54,P<0.01). 干预后SaO2 上升至90%以上,FiO2 下降约15%,氧合指数提高120%,干预前后均存在显著统计学差异(t值分别为4.33、3.57、5.66,均P<0.01). 在治疗后血压未见显著变化(t=0.79,P>0.05),而肺动脉压较治疗前显著下降28%(t=7.51,P<0.01). 治疗后24h与治疗后2h比较,FiO2 较前持续下降约31%(t=6.76,P<0.01),氧合指数提高约83%(t=5.92,P<0.01),存在显著统计学差异. 经治疗有效12例,无效1例,有效率为92.3%. 结论 iNO联合高频震荡通气并西地那非口服治疗能够有效改善患儿血氧指标,对难治性新生儿持续肺动脉高压疗效显著,增加了持续性肺动脉高压抢救成活率.
목적 탐토흡입일양화담( inhaled nitric oxide,iNO)연합고빈진탕통기병서지나비구복대난치성신생인지속폐동맥고압( PPHN)적작용. 방법 수집2012년1월지2014년1월함양시인동의원신생인중증병방수치적경상빈통기가iNO무효적난치성신생인지속성폐동맥고압환인13례,대수시환인경여고빈진탕통기급iNO치료. 비교수시대상치료전후양분압( PaO2 )、이양화탄분압( PaCO2 )、혈양포화도( SaO2 )、흡입양농도( FiO2 )、폐동맥압、평균압、양합지수등적변화. 결과 재치료2h후, PaCO2 미견현저변화(t=0.89,P>0.05),이PaO2 간예전후존재현저통계학차이(t=4.54,P<0.01). 간예후SaO2 상승지90%이상,FiO2 하강약15%,양합지수제고120%,간예전후균존재현저통계학차이(t치분별위4.33、3.57、5.66,균P<0.01). 재치료후혈압미견현저변화(t=0.79,P>0.05),이폐동맥압교치료전현저하강28%(t=7.51,P<0.01). 치료후24h여치료후2h비교,FiO2 교전지속하강약31%(t=6.76,P<0.01),양합지수제고약83%(t=5.92,P<0.01),존재현저통계학차이. 경치료유효12례,무효1례,유효솔위92.3%. 결론 iNO연합고빈진탕통기병서지나비구복치료능구유효개선환인혈양지표,대난치성신생인지속폐동맥고압료효현저,증가료지속성폐동맥고압창구성활솔.
Objective To investigate the clinical effect of inhaled nitric oxide (iNO) combining high frequency oscillatory ventilation ( HFOV) and oral sildenafil for refractory persistent pulmonary hypertension of newborns ( PPHN) .Methods Thirteen cases of refractory PPHN, receiving normal frequency ventilation and nitric oxide inhalation without effect in neonatal intensive care unit ( NICU) of Xianyang Pediatrics Hospital from January 2012 to January 2014, accepted HFOV and iNO therapy.The changes of PaO2 , PaCO2 , SaO2 , FiO2 , pulmonary artery pressure, mean pressure and oxygenation index before and after treatment were analyzed.Results Two hours after the treatment, PaCO2 did not change remarkably (t=0.86,P>0.05), while PaO2 was significantly different (t=4.54,P<0.01).SaO2 increased to 90%, FiO2 decreased to 15%and oxygenation index increased by 120%(t value was 4.33, 3.57 and 5.66, respectively, all P<0.01).After treatment the blood pressure did not change significantly (t=0.79, P>0.05), but pulmonary artery pressure declined by 28%compared with that before treatment (t=7.51, P<0.01).Twenty-four hours after treatment FiO2 showed a sustained decline of about 31%compared that 2 h after treatment (t=6.76, P<0.01) and oxygenation index increased by about 83%(t=5.92,P<0.01) with statistically significant differences.After the treatment, 12 cases obtained effect while 1 case did not, with the effective rate of 92.3%.Conclusion The treatment of iNO combining HFOV and oral sildenafil can effectively improve the blood oxygen index of neonates, and can effectually cure PPHN and improve the rescue survival rate of persistent pulmonary hypertension.