Inhaled nitric oxide in premature infants with the respiratory distress syndrome
Inhaled nitric oxide in premature infants with the respiratory distress syndrome
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DOI：
10.1056/nejmoa031154
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发表时间：
2003-11-27
影响因子：
158.5
通讯作者：
Srisuparp, P
中科院分区：
文献类型：
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作者：
Schreiber, MD;Gin-Mestan, K;Srisuparp, P
背景：吸入一氧化氮可改善气体交换，降低肺血管不稳定性，减轻肺部炎症。我们假设吸入一氧化氮可以降低呼吸窘迫综合征早产儿慢性肺部疾病的发病率和死亡率。方法：我们进行了一项随机、双盲、安慰剂对照的研究，研究了出生第一周吸入一氧化氮对因呼吸窘迫综合征而接受机械通气的早产儿(胎龄<34周)的慢性肺部疾病发病率和死亡率的影响。婴儿被随机分配接受吸入一氧化氮(第1天10ppm，随后连续6天5ppm)或吸入氧气安慰剂7天。我们进一步随机将每组婴儿分为间歇性强制呼吸机和高频振荡呼吸机。结果：共纳入早产儿207例。吸入一氧化氮组中，51名婴儿(48.6%)死亡或患有慢性肺部疾病，而安慰剂组有65名婴儿(63.7%)(相对风险0.76；95%可信区间0.60至0.97；P=0.03)。在脑室出血和脑室周围白质软化的总发生率方面，一氧化氮组和安慰剂组之间没有显著差异(分别为33.3%和38.2%)，但吸入一氧化氮的组严重脑室出血和脑室周围白质软化的发生率较低(12.4%对23.5%；相对危险度0.53；95%可信区间0.28至0.98；P=0.04)。结论：吸入一氧化氮治疗早产儿呼吸窘迫综合征可降低慢性肺部疾病的发生率和死亡率。
Background: Inhaled nitric oxide improves gas exchange, decreases pulmonary vascular lability, and reduces pulmonary inflammation. We hypothesized that the use of inhaled nitric oxide would decrease the incidence of chronic lung disease and death in premature infants with the respiratory distress syndrome.Methods: We conducted a randomized, double-blind, placebo-controlled study of the effect of inhaled nitric oxide during the first week of life on the incidence of chronic lung disease and death in premature infants (less than 34 weeks' gestation) who were undergoing mechanical ventilation for the respiratory distress syndrome. Infants were randomly assigned to receive inhaled nitric oxide (10 ppm on day 1, followed by 5 ppm for six days) or inhaled oxygen placebo for seven days. We further randomly assigned the infants in each group to receive intermittent mandatory or high-frequency oscillatory ventilation.Results: A total of 207 premature infants were enrolled. In the group given inhaled nitric oxide, 51 infants (48.6 percent) died or had chronic lung disease, as compared with 65 infants (63.7 percent) in the placebo group (relative risk, 0.76; 95 percent confidence interval, 0.60 to 0.97; P=0.03). There was no significant difference between the nitric oxide and placebo groups in the overall incidence of intraventricular hemorrhage and periventricular leukomalacia (33.3 percent and 38.2 percent, respectively), but the group given inhaled nitric oxide had a lower incidence of severe intraventricular hemorrhage and periventricular leukomalacia (12.4 percent vs. 23.5 percent; relative risk, 0.53; 95 percent confidence interval, 0.28 to 0.98; P=0.04). The type of ventilation had no significant effect on the outcome.Conclusions: The use of inhaled nitric oxide in premature infants with the respiratory distress syndrome decreases the incidence of chronic lung disease and death.