新生儿持续肺动脉高压最新治疗进展
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摘要
新生儿持续肺动脉高压(PPHN)是新生儿重症监护区最常见的疾病之一。可因先天性发育异常、围生期缺氧、感染等因素使肺血管压力增高,导致出生后右心血液不能有效进入肺内氧合,产生严重低氧血症。因发病机制的不同,新生儿持续肺动脉高压有别于儿童或者成人肺动脉高压的治疗。目前治疗PPHN的方法主要有高频机械通气、吸入NO、磷酸二酯酶抑制剂等方法。本综述旨在针对继发性PPHN寻求最新且全面的治疗方法。
Persistent pulmonary hypertension of the newborn(PPHN) is one of the most common diseases in the neonatal intensive care unit.Because of congenital developmental abnormalities,perinatal hypoxia,infection and other factors,pulmonary vascular pressure increases,resulting in the right heart blood after birth can not effectively enter the pulmonary oxygenation,resulting in severe hypoxemia eventually.Due to different pathogenesis,the treatment persistent pulmonary hypertension of newborn is different from that in children or adults.At present,the main methods of PPHN treatment are high frequency mechanical ventilation,inhalation of NO,phosphodiesterase inhibitors and so on.This review aim to seek the latest and comprehensive treatment for secondary PPHN.
Persistent pulmonary hypertension of the newborn(PPHN) is one of the most common diseases in the neonatal intensive care unit.Because of congenital developmental abnormalities,perinatal hypoxia,infection and other factors,pulmonary vascular pressure increases,resulting in the right heart blood after birth can not effectively enter the pulmonary oxygenation,resulting in severe hypoxemia eventually.Due to different pathogenesis,the treatment persistent pulmonary hypertension of newborn is different from that in children or adults.At present,the main methods of PPHN treatment are high frequency mechanical ventilation,inhalation of NO,phosphodiesterase inhibitors and so on.This review aim to seek the latest and comprehensive treatment for secondary PPHN.
引文
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[5]Dani C,Corsini I,Cangemi J,et al.Nitric oxide for the treatment of preterm infants with severe RDS and pulmonary hypertension[J].Pediatric Pulmonology,2017,52(11):1461-1468.
[6]De B W P,Yogen S,Zoltan M,et al.Application of Neonatologist Performed Echocardiography in the assessment and management of persistent pulmonary hypertension of the newborn[J].Pediatric Research,2018,84(S1):68-77.
[7]Bhattacharya S,Sen S,Levy P T,et al.Comprehensive Evaluation of Right Heart Performance and Pulmonary Hemodynamics in Neonatal Pulmonary Hypertension[J].Current Treatment Options in Cardiovascular Medicine,2019,21(2):10.
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[11]Ellsworth K R,Ellsworth M A,Weaver A L,et al.Association of Early Inhaled Nitric Oxide With the Survival of Preterm Neonates With Pulmonary Hypoplasia[J].Jama Pediatr,2018,172(7):e180761.
[12]Hussain A S,Ali R,Ahmed S,et al.Oral sildenafil use in Neonates with persistent pulmonary hypertension of Newborn[J].J Ayub Med Coll Abbottabad,2017,29(4):677-680.
[13]刘九月,李同川,张慧娟,等.高频振荡通气联合西地那非治疗新生儿持续性肺动脉高压[J].新乡医学院学报,2014,31(1):51-53.
[14]Shah P S,Ohlsson A.Sildenafil for pulmonary hypertension in neonates[J].Cochrane Database Syst Rev,2017,39(8):CD005494.
[15]寇晨,张巍.磷酸二酯酶抑制剂在新生儿持续肺动脉高压治疗中的研究进展[J].儿科药学杂志,2013,19(6):57-59.
[16]Giaccone A,Zuppa A F,Sood B,et al.Milrinone Pharmacokinetics and Pharmacodynamics in Neonates with Persistent Pulmonary Hypertension of the Newborn[J].American Journal of Perinatology,2017,34(8):749-758.
[17]黄海波,刘海英,易璐,等.前列地尔联合常频通气治疗新生儿持续肺动脉高压疗效观察[J].中国实用儿科杂志,2012,27(12):940-941.
[18]Mei M,Cheng G,Sun B,et al.EDN1 Gene Variant is Associated with Neonatal Persistent Pulmonary Hypertension[J].Scientific Reports,2016,6(1):29877.
[19]More K,Athalye-Jape G K,Rao S C,et al.Endothelin receptor antagonists for persistent pulmonary hypertension in term and late preterm infants:Reviews[M].Cochrane Database of Systematic Reviews.Cochrane Database Syst Rev,2016.
[20]Steinhorn R H,Fineman J,Kusic-Pajic A,et al.Bosentan as Adjunctive Therapy for Persistent Pulmonary Hypertension of the Newborn:Results of the Randomized Multicenter Placebo-Controlled Exploratory Trial[J].The Journal of Pediatrics,2016(177):90-96.
[21]Maneenil G,Thatrimontrichai A,Janjindamai W,et al.Effect of bosentan therapy in persistent pulmonary hypertension of the newborn[J].Pediatrics&Neonatology,2017,59(1):58-64.
[22]洪小杨,周更须,李秋平,等.体外膜肺氧合技术在新生儿呼吸衰竭中的应用[J].中国小儿急救医学,2014,21(10):629-632.
[23]K?ssel H,Bauer K,Kewitz G,et al.Do we need new indications for ECMO in neonates pretreated with high-frequency ventilation and/or inhaled nitric oxide?[J].Intensive Care Med,2000,26(10):1489-1495.
[24]Nakwan N,Chaiwiriyawong P.An international survey on persistent pulmonary hypertension of the newborn:A need for an evidence-based management[J].Journal of Neonatal-Perinatal Medicine,2016,9(3):243-250.
[25]Jonas P,Hedegaard E R,Ulf S,et al.Current and Future Treatments for Persistent Pulmonary Hypertension in the Newborn[J].Basic&Clinical Pharmacology&Toxicology,2018,123(4).
[2]Steurer M A,Jelliffe-Pawlowski L L,Baer R J,et al.Persistent Pulmonary Hypertension of the Newborn in Late Preterm and Term Infants in California[J].Pediatrics,2017,139(1):e20161165.
[3]Nakwan N,Jain S,Kumar K,et al.An Asian multicenter retrospective study on persistent pulmonary hypertension of the newborn:incidence,etiology,diagnosis,treatment and outcome[J].Journal of Maternal-Fetal and Neonatal Medicine,2018:1-11.
[4]杜立中.新生儿持续肺动脉高压诊治的若干进展[A].全国儿科学新进展、急重症诊治新技术学术会议[C].广州:中国小儿急救医学,2007.
[5]Dani C,Corsini I,Cangemi J,et al.Nitric oxide for the treatment of preterm infants with severe RDS and pulmonary hypertension[J].Pediatric Pulmonology,2017,52(11):1461-1468.
[6]De B W P,Yogen S,Zoltan M,et al.Application of Neonatologist Performed Echocardiography in the assessment and management of persistent pulmonary hypertension of the newborn[J].Pediatric Research,2018,84(S1):68-77.
[7]Bhattacharya S,Sen S,Levy P T,et al.Comprehensive Evaluation of Right Heart Performance and Pulmonary Hemodynamics in Neonatal Pulmonary Hypertension[J].Current Treatment Options in Cardiovascular Medicine,2019,21(2):10.
[8]周伟,荣箫.高频振荡通气在新生儿的应用[J].中国新生儿科杂志,2012,9(4):135-137.
[9]董世霄,刘红,钱素云.高频振荡通气治疗新生儿持续肺动脉高压疗效评价[J].山西医科大学学报,2012,43(9):700-703.
[10]Fernanda B,Lucía V,Fernando S,et al,Efficacy and safety of a novel nitric oxide generator for the treatment of neonatal pulmonary hypertension:Experimental and clinical studies[J].Pulmonary Pharmacology&Therapeutics,2019(54):68-76.
[11]Ellsworth K R,Ellsworth M A,Weaver A L,et al.Association of Early Inhaled Nitric Oxide With the Survival of Preterm Neonates With Pulmonary Hypoplasia[J].Jama Pediatr,2018,172(7):e180761.
[12]Hussain A S,Ali R,Ahmed S,et al.Oral sildenafil use in Neonates with persistent pulmonary hypertension of Newborn[J].J Ayub Med Coll Abbottabad,2017,29(4):677-680.
[13]刘九月,李同川,张慧娟,等.高频振荡通气联合西地那非治疗新生儿持续性肺动脉高压[J].新乡医学院学报,2014,31(1):51-53.
[14]Shah P S,Ohlsson A.Sildenafil for pulmonary hypertension in neonates[J].Cochrane Database Syst Rev,2017,39(8):CD005494.
[15]寇晨,张巍.磷酸二酯酶抑制剂在新生儿持续肺动脉高压治疗中的研究进展[J].儿科药学杂志,2013,19(6):57-59.
[16]Giaccone A,Zuppa A F,Sood B,et al.Milrinone Pharmacokinetics and Pharmacodynamics in Neonates with Persistent Pulmonary Hypertension of the Newborn[J].American Journal of Perinatology,2017,34(8):749-758.
[17]黄海波,刘海英,易璐,等.前列地尔联合常频通气治疗新生儿持续肺动脉高压疗效观察[J].中国实用儿科杂志,2012,27(12):940-941.
[18]Mei M,Cheng G,Sun B,et al.EDN1 Gene Variant is Associated with Neonatal Persistent Pulmonary Hypertension[J].Scientific Reports,2016,6(1):29877.
[19]More K,Athalye-Jape G K,Rao S C,et al.Endothelin receptor antagonists for persistent pulmonary hypertension in term and late preterm infants:Reviews[M].Cochrane Database of Systematic Reviews.Cochrane Database Syst Rev,2016.
[20]Steinhorn R H,Fineman J,Kusic-Pajic A,et al.Bosentan as Adjunctive Therapy for Persistent Pulmonary Hypertension of the Newborn:Results of the Randomized Multicenter Placebo-Controlled Exploratory Trial[J].The Journal of Pediatrics,2016(177):90-96.
[21]Maneenil G,Thatrimontrichai A,Janjindamai W,et al.Effect of bosentan therapy in persistent pulmonary hypertension of the newborn[J].Pediatrics&Neonatology,2017,59(1):58-64.
[22]洪小杨,周更须,李秋平,等.体外膜肺氧合技术在新生儿呼吸衰竭中的应用[J].中国小儿急救医学,2014,21(10):629-632.
[23]K?ssel H,Bauer K,Kewitz G,et al.Do we need new indications for ECMO in neonates pretreated with high-frequency ventilation and/or inhaled nitric oxide?[J].Intensive Care Med,2000,26(10):1489-1495.
[24]Nakwan N,Chaiwiriyawong P.An international survey on persistent pulmonary hypertension of the newborn:A need for an evidence-based management[J].Journal of Neonatal-Perinatal Medicine,2016,9(3):243-250.
[25]Jonas P,Hedegaard E R,Ulf S,et al.Current and Future Treatments for Persistent Pulmonary Hypertension in the Newborn[J].Basic&Clinical Pharmacology&Toxicology,2018,123(4).