吸入一氧化氮联合高频震荡通气治疗新生儿重症肺炎的临床效果分析
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摘要
目的探讨吸入一氧化氮(nitric oxide,NO)联合高频震荡通气(high-frequency oscillatory ventilation,HFOV)治疗新生儿重症肺炎的临床效果。方法选择2012年1月—2016年12月我院儿科收治的54例新生儿重症肺炎患儿作为研究对象,随机分为观察组(吸入NO联合HFOV治疗)和对照组(HFOV治疗),每组27例,分别记录2组治疗前和治疗后1,6,24h呼吸功能指标和血气指标,以及治疗后肺功能指标和重度肺炎相关临床体征消失时间。结果 2组平均气道压(mean airway pressure,MAP)、吸入氧浓度(fraction of inspiration O_2,FiO_2)、氧合指数(oxygenation index,OI)及动脉肺泡氧分压比值(a/A)在时点间、组间·时点间交互作用差异均有统计学意义(P<0.05),在组间差异无统计学意义(P>0.05)。2组动脉血氧分压(partial pressure of oxygen,PaO_2)、二氧化碳分压(partial pressure of carbon dioxide,PaCO_2)及pH值在时点间、组间·时点间交互作用差异均有统计学意义(P<0.05),在组间差异无统计学意义(P>0.05)。观察组治疗后用力肺活量(forced vital capacity,FVC)、1秒用力呼气容积(forced expiratory volume in one second,FEV_1)、最大用力呼气峰流量(peak expiratory flow,PEF)明显低于对照组,差异均有统计学意义(P<0.05)。观察组治疗后重度肺炎相关的三凹征、肺部啰音、发热、发绀及鼻翼扇动等临床体征消失时间明显短于对照组,差异均有统计学意义(P<0.05)。结论吸入NO联合高频震荡通气治疗新生儿重症肺炎,可以明显改善患儿的呼吸功能和血气指标,并显著改善肺功能和重度肺炎相关的临床体征,具有一定临床应用和研究价值。
Objective To investigate the clinical efficacy of inhaled nitric oxide(NO)combined with high frequency shock ventilation(HFOV)in the treatment of neonatal severe pneumonia.Methods From January 2012 to December 2016,54 children with severe neonatal severe pneumonia were enrolled in this study.They were randomly divided into observation group(inhaled NO combined with HFOV treatment)and control group(HFOV treatment),each group of 27 cases.The respiratory function index and blood gas index,and the lung function index after treatment and the time of disappearance of severe pneumonia-related clinical signs were recorded before and 1 h,6 hand 24 hafter treatment.Results The mean airway pressure(MAP),inspired oxygen volume fraction(FiO_2),oxygenation index(OI),and a/A interaction between time points and between groups and time points in the two groups were statistically significant(P<0.05).There was no significant difference between the groups(P>0.05).The differences in arterial oxygen partial pressure(PaO_2),carbon dioxide partial pressure(PaCO_2),and pH between the two groups were statistically significant(P<0.05).There was no significant difference between the groups(P>0.05).The forced vital capacity(FVC),forced expiratory volume in one second(FEV_1),and peak expiratory flow(PEF)after treatment in the observation group were significantly lower than those in the control group(P<0.05).The time of disappearance of clinical signs such as three-indented sign,pulmonary rales,fever,cyanosis,and alar fan was significantly shorter in the observation group than in the control group.The difference was statistically significant(P<0.05).Conclusion Inhaled nitric oxide combined with high frequency shock ventilation in the treatment of neonatal severe pneumonia can significantly improve the children′s respiratory function and blood gas index,and significantly improve the lung function and severe pneumonia-related clinical signs,has a certain clinical application and research value.
Objective To investigate the clinical efficacy of inhaled nitric oxide(NO)combined with high frequency shock ventilation(HFOV)in the treatment of neonatal severe pneumonia.Methods From January 2012 to December 2016,54 children with severe neonatal severe pneumonia were enrolled in this study.They were randomly divided into observation group(inhaled NO combined with HFOV treatment)and control group(HFOV treatment),each group of 27 cases.The respiratory function index and blood gas index,and the lung function index after treatment and the time of disappearance of severe pneumonia-related clinical signs were recorded before and 1 h,6 hand 24 hafter treatment.Results The mean airway pressure(MAP),inspired oxygen volume fraction(FiO_2),oxygenation index(OI),and a/A interaction between time points and between groups and time points in the two groups were statistically significant(P<0.05).There was no significant difference between the groups(P>0.05).The differences in arterial oxygen partial pressure(PaO_2),carbon dioxide partial pressure(PaCO_2),and pH between the two groups were statistically significant(P<0.05).There was no significant difference between the groups(P>0.05).The forced vital capacity(FVC),forced expiratory volume in one second(FEV_1),and peak expiratory flow(PEF)after treatment in the observation group were significantly lower than those in the control group(P<0.05).The time of disappearance of clinical signs such as three-indented sign,pulmonary rales,fever,cyanosis,and alar fan was significantly shorter in the observation group than in the control group.The difference was statistically significant(P<0.05).Conclusion Inhaled nitric oxide combined with high frequency shock ventilation in the treatment of neonatal severe pneumonia can significantly improve the children′s respiratory function and blood gas index,and significantly improve the lung function and severe pneumonia-related clinical signs,has a certain clinical application and research value.
引文
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[15]Bhatraju P,Crawford J,Hall M,et al.Inhaled nitric oxide:Current clinical concepts[J].Nitric Oxide,2015,50:114-128.
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[18]Nahar K,Rashid J,Absar S,et al.Liposomal Aerosols of Nitric Oxide(NO)Donor as a Long-Acting Substitute for the Ultra-Short-Acting Inhaled NO in the Treatment of PAH[J].Pharm Res,2016,33(7):1696-1710.
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[20]De LD,Costa R,Visconti F,et al.Oscillation transmission and volume delivery during face mask-delivered HFOV in infants:Bench and in vivo study[J].Pediatr Pulm,2016,51(7):705-712.
[2]李新江,方艳伟,魏浩飞,等.早期持续性高容量血液滤过对重症急性胰腺炎急性肺损伤患者的影响[J].河北医科大学学报,2016,37(2):198-201.
[3]Peden WM,Richard JL,Trampel DW,et al.Mycotic Pneumonia and Meningoencephalitis due to Aspergillus terreus in a Neonatal Snow Leopard(Panthera uncia)[J].J Wildlife Dis,2015,21(3):301-305.
[4]Roux DML,Myer L,Nicol MP,et al.Incidence and severity of childhood pneumonia in the first year of life in a South African birth cohort:the Drakenstein Child Health Study[J].Lancet Glob Health,2015,3(2):e95.
[5]Ruan SY,Wu HY,Lin HH,et al.Inhaled nitric oxide and the risk of renal dysfunction in patients with acute respiratory distress syndrome:apropensity-matched cohort study[J].Crit Care,2016,20(1):389.
[6]Sokol GM,Konduri GG,Van Meurs KP.Inhaled nitric oxide therapy for pulmonary disorders of the term and preterm infant[J].Semin Perinatol,2016,40(6):356.
[7]Maitra S,Bhattacharjee S,Khanna P,et al.High-frequency ventilation does not provide mortality benefit in comparison with conventional lung-protective ventilation in acute respiratory distress syndrome:a meta-analysis of the randomized controlled trials[J].Anesthesiology,2015,122(4):841-851.
[8]邵民坤,周燕,杜坤,等.炎性指标联合检测在鉴别诊断新生儿感染中的临床评价[J].中华医院感染学杂志,2016,26(7):1639-1641.
[9]龙小平,秦志强.无创与有创通气治疗慢性阻塞性肺疾病并严重呼吸衰竭的临床对照研究[J].河北医科大学学报,2011,32(9):1052-1055.
[10]Hawkes MT,Conroy AL,Opoka RO,et al.Inhaled nitric oxide as adjunctive therapy for severe malaria:a randomized controlled trial[J].Malar J,2015,14(1):421.
[11]Finer NN,Evans N.Inhaled nitric oxide for the preterm infant:evidence versus practice[J].Pediatrics,2015,135(4):754-756.
[12]李培燕.78例新生儿吸入性肺炎的临床诊疗分析[J].河北医科大学学报,2015,36(2):159-161.
[13]Ruan SY,Huang TM,Wu HY,et al.Inhaled nitric oxide therapy and risk of renal dysfunction:a systematic review and meta-analysis of randomized trials[J].Crit Care,2015,19(1):137.
[14]Asadi AK,SaRC,Kim NH,et al.Inhaled nitric oxide alters the distribution of blood flow in the healthy human lung,suggesting active hypoxic pulmonary vasoconstriction in normoxia[J].J Appl Physiol,2015,118(3):331-343.
[15]Bhatraju P,Crawford J,Hall M,et al.Inhaled nitric oxide:Current clinical concepts[J].Nitric Oxide,2015,50:114-128.
[16]Ye Q,Shao W,Shang S,et al.Epidemiological characteristics and immune status of children with Respiratory Syncytial Virus[J].J Med Virol,2015,87(2):323.
[17]Ben-Shimol S,Greenberg D,Hazan G,et al.Differential impact of pneumococcal conjugate vaccines on bacteremic pneumonia versus other invasive pneumococcal disease[J].Pediatr Infect Dis J,2015,34(4):409-416.
[18]Nahar K,Rashid J,Absar S,et al.Liposomal Aerosols of Nitric Oxide(NO)Donor as a Long-Acting Substitute for the Ultra-Short-Acting Inhaled NO in the Treatment of PAH[J].Pharm Res,2016,33(7):1696-1710.
[19]Bronicki RA,Fortenberry J,Schreiber M,et al.Multicenter Randomized Controlled Trial of Inhaled Nitric Oxide for Pediatric Acute Respiratory Distress Syndrome[J].J Pediatrics,2015,166(2):365-369.
[20]De LD,Costa R,Visconti F,et al.Oscillation transmission and volume delivery during face mask-delivered HFOV in infants:Bench and in vivo study[J].Pediatr Pulm,2016,51(7):705-712.