摘要
目的探讨用高频振荡通气、肺表面活性物质联合一氧化氮吸入的"三联疗法"治疗新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)合并持续肺动脉高压(persistent pulmonary hypertension of the new born,PPHN)的临床效果。方法 2010年1月1日至2017年6月30日在厦门市妇幼保健院新生儿科住院,确诊为RDS合并PPHN患儿31例,均应用"三联疗法"治疗。对其临床特征和转归进行分析,比较治疗前及治疗后24、48小时的p H值、氧合指数(oxygenation index,OI)、肺动脉压力(pulmonary artery pressure,PAP)、动脉血氧分压(arterial oxygen tension,Pa O2)/吸入氧气分数(fraction of inspired oxygen,Fi O2)值的变化。统计学分析采用t检验,χ2检验和重复测量方差分析。结果 31例患儿平均胎龄(36.2±2.9)周,其中晚期早产儿14例(45.2%,14/31),足月儿11例(35.5%,11/31)。剖宫产24例(77.4%,24/31),其中选择性剖宫产21例(67.7%,21/31)。31例患儿治疗前的平均OI值为36±16,平均PAP为(57±11)mm Hg,平均P/F值为53±27,不同程度OI值、PAP、P/F值的患儿转归差异无统计学意义(P﹥0.05)。治疗后24、48小时的p H值、Pa O2、Pa CO2均较治疗前明显改善,OI值、PAP均较治疗前明显下降,P/F值明显上升,差异有统计学意义(P﹤0.05)。平均住院时间为(22±11)天。治愈24例(77.4%,24/31),好转5例(16.1%,5/31),死亡2例(6.5%,2/31)。对于OI值≥40、PAP﹥70 mm Hg、P/F值﹤50的危重患儿,"三联疗法"的临床治愈好转率分别为83.3%(5/6)、80.0%(4/5)和94.1%(16/17)。结论 "三联疗法"治疗RDS合并PPHN,可以起到协同作用,显著改善患儿氧合,提高抢救成功率;对于极危重患儿,"三联疗法"可以减少其对体外膜肺氧合技术的需求。
Objective To explore the clinical effectiveness of the triple therapy of high-frequency oscillation ventilation（HFOV）, pulmonary surfactant（PS） and inhaled nitric oxide（i NO） in infants with respiratory distress syndrome（RDS） combined with persistent pulmonary hypertension（PPHN）. MethodsFrom January 1 st 2010 to June 30 th 2017, 31 infants diagnosed as RDS complicated with PPHN were admitted to Neonatal Department of Maternal and Child Health Care Hospital of Xiamen and all of the cases were treated by the triple therapy. The clinical characteristics and outcomes were analyzed. The p H value, oxygenation index（OI）, pulmonary arterial pressure（PAP）, and Pa O2/Fi O2（P/F） were compared before and after treatment for 24 and 48 hours. T test, Chi-square test and repeated measure of ANOVA were used for statistical analysis. Results The mean gestational age of 31 infants was（36.2±2.9） weeks, 14 cases were late preterm infants（45.2%, 14/31）, 11 cases were full-term infants（35.5%, 11/31）. 24 cases were delivered by cesarean section（77.4%, 24/31）, among which 21 cases were selective cesarean section（67.7%, 21/31）. The mean OI value, PAP value and P/F ratio of the 31 cases were 36±16,（57±11） mm Hg and 53±27 respectively before the triple therapy. There were no significant differences of the outcomes in varying degrees of OI values, PAP value and P/F ratio（P ﹥ 0.05）. After 24 and 48 hours of triple therapy, the values of p H, Pa O2 and Pa CO2 were significantly improved, and the values of OI and PAP were significantly decreased and the P/F ratios were significantly increased compared with those before the triple therapy（P ﹤ 0.05）. The average length of hospital stay was（22±11） days. 24 cases were cured（77.4%, 24/31）, 5 cases were improved（16.1%,5/31） and 2 cases died（6.5%, 2/31）. The cure and improvement rates of the triple therapy were 83.3%（5/6）, 80.0%（4/5） and 94.1%（16/17） respectively in the critically ill infants with OI
作者
林新祝
刘龙宾
唐丽霞
祝垚
陈超
LIN Xin-zhu;LIU Long-bin;TANG Li-xia;ZHU Yao;CHEN Chao(Neonatal Department,Maternal and Child Health Care Hospital,Xiamen,Fujian 361000,China;Neonatal Department,Children＇s Hospital of Fudan University,Shanghai 201102,China)
出处
《发育医学电子杂志》
2018年第3期166-171,共6页
Journal of Developmental Medicine (Electronic Version)
基金
2017年厦门市科技计划重大专项立项(3502Z20171006)
关键词
高频振荡通气
肺表面活性物质
一氧化氮吸入
呼吸窘迫综合征
持续肺动脉高压
新生儿
High-frequency oscillation ventilation
Pulmonary surfactant
Inhaledd nitric oxide
Respiratory distress syndrome
Persistent pulmonary hypertension
Neonate
