Clinical responses to prolonged treatment of persistent pulmonary hypertension of the newborn with low doses of inhaled nitric oxide.
Clinical responses to prolonged treatment of persistent pulmonary hypertension of the newborn with low doses of inhaled nitric oxide.
复制标题
低剂量吸入一氧化氮长期治疗新生儿持续性肺动脉高压的临床反应。
DOI：
10.1016/s0022-3476(05)81551-3
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Abman,SH
中科院分区：
文献类型：
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作者：
Kinsella,JP;Neish,SR;Ivy,DD;Shaffer,E;Abman,SH
我们研究了低剂量一氧化氮吸入治疗9例新生儿重度持续性肺动脉高压（PPHN）患者的疗效，这些患者是体外膜肺氧合（ECMO）的候选人。尽管积极的呼吸机管理和肺动脉高压的超声心动图证据，所有患者都有明显的低氧血症。相关诊断包括胎粪吸入综合征（3例患者）、脓毒症（3例患者）和先天性疝（2例患者）。婴儿最初以20 ppm吸入一氧化氮4小时，然后以6 ppm吸入20小时。在所有婴儿中，氧合迅速改善（基线时动脉/肺泡氧比为0.077±0.016，4小时为0.193±0.030;p<0.001），而全身血压没有降低。8例患者吸入6 ppm一氧化氮24小时后，氧合持续改善（24小时动脉/肺泡氧比为0.270±0.053;p<0.001 vs基线）。1例严重脓毒症患者的一氧化氮氧合初步改善，但需要ECMO治疗多器官功能障碍和心功能障碍。我们的结论是，低剂量的一氧化氮引起持续的严重PPHN的临床改善，并可能减少对ECMO的需要。然而，在选择的PPHN并发严重的全身血流动力学崩溃的病例中，立即使用ECMO是重要的。
We studied the efficacy of low-dose nitric oxide inhalation in nine consecutive patients with severe persistent pulmonary hypertension of the newborn (PPHN) who were candidates for extracorporeal membrane oxygenation (ECMO). All patients had marked hypoxemia despite aggressive ventilator management and echocardiographic evidence of pulmonary hypertension. Associated diagnoses included meconium aspiration syndrome (3 patients), sepsis (3 patients), and congenital diaphragmatic hernia (2 patients). Infants were initially treated with inhaled nitric oxide at 20 ppm for 4 hours and then at 6 ppm for 20 hours. In all infants, oxygenation promptly improved (arterial/alveolar oxygen ratio, 0.077±0.016 at baseline vs 0.193±0.030 at 4 hours;p<0.001) without a decrease in systemic blood pressure. Sustained improvement in oxygenation was achieved in eight patients treated with inhaled nitric oxide for 24 hours at 6 ppm (arterial/alveolar oxygen ratio, 0.270±0.053 at 24 hours;p<0.001 vs baseline). One patient with overwhelming sepsis had an initial improvement of oxygenation with nitric oxide but required ECMO for multiorgan and cardiac dysfunction. We conclude that low doses of nitric oxide cause sustained clinical improvement in severe PPHN and may reduce the need for ECMO. However, immediate availability of ECMO is important in selected cases of PPHN complicated by severe systemic hemodynamic collapse.