机械通气联合NO吸入治疗新生儿重症肺炎
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摘要
目的探讨早期机械通气联合一氧化氮吸入治疗新生儿重症肺炎的疗效。方法选择2012年1月至2017年5月来院新生儿科收治的80例重症肺炎新生儿作为研究对象,将所有患儿随机分为观察组和对照组,每组40例。对照组患儿采用早期机械通气治疗,观察组患儿在早期机械通气联合NO吸入治疗,分别记录两组患儿治疗前和治疗后1h、6h、24h的呼吸功能指标和血气指标,及治疗后的肺功能指标和重度肺炎相关临床体征消失的时间。结果两组患儿治疗后6、24h的MAP和治疗后1、6、24h的FiO2、OI均明显低于治疗前,且治疗后1、6、24h的a/A明显高于治疗前,差异均有统计学意义(P<0.05),观察组患儿治疗后6、24h的MAP、FiO2、OI及a/A与对照组相比,差异均具有统计学意义(P<0.05);两组患儿治疗后1、6、24h的PaO2和pH值明显高于治疗前,且PaCO2明显低于治疗前,差异均有统计学意义(P﹤0.05),观察组患儿治疗后6、24h的PaO2、PaCO2及pH值与对照组相比,差异均具有统计学意义(P﹤0.05);观察组患儿治疗后的FVC、FEV1、PEF显著低于对照组,差异具有统计学意义(P<0.05);观察组患儿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的时间显著优于对照组,差异具有统计学意义(P<0.05);观察组患儿机械通气持续时间明显短于对照组,差异具有统计学意义(P<0.05);观察组患儿治疗后的出血时间、凝血时间及血小板计数与对照组相比无统计学差异(P>0.05)。结论采取早期机械通气联合NO吸入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,且未出现出凝血时间延长的副作用,具有一定的临床应用价值。
Objective To investigate the effect of early mechanical ventilation combined with nitric oxide inhalation on neonatal severe pneumonia.Methods Eighty patients with severe pneumonia were enrolled in our hospital from January 2012 to May 2017.All children were randomly divided into observation group and control group(n=40).The patients in the control group were treated with early mechanical ventilation.The patients in the observation group were treated with early mechanical ventilation combined with NO inhalation.The respiratory function indexes and blood gas indexes of the two groups were recorded before and 1h,6hand 24 hafter treatment respectively.Of the lung function indicators and severe pneumonia related to the disappearance of clinical signs of time.Results The levels of FiO2 and OI at 6and 24 hours after treatment were significantly lower than those before treatment at 1,6and 24 hours after treatment,and the a/A at 1,6and 24 hours after treatment was significantly higher than that before treatment(P<0.05).The MAP,FiO2,OI and a/A of the observation group were statistically significant at 6and 24 hours after treatment(P<0.05),and the difference was statistically significant(P<0.05).PaO2 and pH were significantly higher than those before treatment,and PaCO2 was significantly lower than that before treatment(P<0.05).The children in the observation group had 6,24 hafter treatment(P<0.05).The levels of FVC,FEV1 and PEF in the observation group were significantly lower than those in the control group(P<0.05),and the difference was statistically significant(P<0.05).The time of disappearance of clinical signs such as triad,pulmonary rales,fever,cyanosis and nasal flap were significantly higher than those in the control group(P<0.05),and the difference was statistically significant(P<0.05).The duration of mechanical ventilation in the observation group was significantly shorter than that in the control group,the difference was statistically significant(P<0.05).There was no significant difference in bleeding time,coagulation time and platelet count between the observation group and the control group(P>0.05).Conclusion Early mechanical ventilation combined with NO can significantly improve the respiratory function and blood gas index of children,and significantly improve the lung function and severe pneumonia related clinical signs,and no side effects of prolonged clotting,has a certain clinical value.
Objective To investigate the effect of early mechanical ventilation combined with nitric oxide inhalation on neonatal severe pneumonia.Methods Eighty patients with severe pneumonia were enrolled in our hospital from January 2012 to May 2017.All children were randomly divided into observation group and control group(n=40).The patients in the control group were treated with early mechanical ventilation.The patients in the observation group were treated with early mechanical ventilation combined with NO inhalation.The respiratory function indexes and blood gas indexes of the two groups were recorded before and 1h,6hand 24 hafter treatment respectively.Of the lung function indicators and severe pneumonia related to the disappearance of clinical signs of time.Results The levels of FiO2 and OI at 6and 24 hours after treatment were significantly lower than those before treatment at 1,6and 24 hours after treatment,and the a/A at 1,6and 24 hours after treatment was significantly higher than that before treatment(P<0.05).The MAP,FiO2,OI and a/A of the observation group were statistically significant at 6and 24 hours after treatment(P<0.05),and the difference was statistically significant(P<0.05).PaO2 and pH were significantly higher than those before treatment,and PaCO2 was significantly lower than that before treatment(P<0.05).The children in the observation group had 6,24 hafter treatment(P<0.05).The levels of FVC,FEV1 and PEF in the observation group were significantly lower than those in the control group(P<0.05),and the difference was statistically significant(P<0.05).The time of disappearance of clinical signs such as triad,pulmonary rales,fever,cyanosis and nasal flap were significantly higher than those in the control group(P<0.05),and the difference was statistically significant(P<0.05).The duration of mechanical ventilation in the observation group was significantly shorter than that in the control group,the difference was statistically significant(P<0.05).There was no significant difference in bleeding time,coagulation time and platelet count between the observation group and the control group(P>0.05).Conclusion Early mechanical ventilation combined with NO can significantly improve the respiratory function and blood gas index of children,and significantly improve the lung function and severe pneumonia related clinical signs,and no side effects of prolonged clotting,has a certain clinical value.
引文
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[12] Soraisham A S,Harabor A,Shivananda S,et al.Trends and Variations in the Use of Inhaled Nitric Oxide in Preterm Infants in Canadian Neonatal Intensive Care Units[J].American Journal of Perinatology,2016,33(07):715-722.
[13] Watabe Y,Watabe Y,Kano Y,et al.Study about the Efficacy and Safety of Inhaled Nitric Oxide Therapy as Treatment for Persistent Pulmonary Hypertension of the Newborn[J].Dokkyo Journal of Medical Sciences,2015,42(2):71-75.
[14] Finer N N,Evans N.Inhaled nitric oxide for the preterm infant:evidence versus practice[J].Pediatrics,2015,135(4):754-756.
[15] Carey W A,Ellsworth M A,Harris M N.Inhaled Nitric Oxide Use in the Neonatal Intensive Care Unit:Rising Costs and the Need for a New Research Paradigm[J].Jama Pediatr,2016,170(7):639-640.
[16] Sokol G M,Konduri G G,Van Meurs K P.Inhaled nitric oxide therapy for pulmonary disorders of the term and preterm infant[J].Seminars in Perinatology,2016,40(6):356.
[17] Handley S C,Steinhorn R H,Hopper A O,et al.Inhaled nitric oxide use in preterm infants in California neonatal intensive care units[J].Journal of Perinatology,2016,36(8):635-639.
[18] Gaddam Bhoomaiah S,Rasiah S V.Outcomes of inhaled nitric oxide in preterm neonates–a five‐year experience in a tertiary neonatal centre[J]. Acta Paediatrica,2015,104(9):880-882.
[19] Lemke R P,Belik J,Giddins N G,et al.Clinical Experience in the Use of Inhaled Nitric Oxide in Infants with Pulmonary Hypertension[J].2016,3(5):295-300.
[20] Martusevich A K,Peretyagin S P,Soloveva A G,et al.Experimental investigation of some systemic effects of nitric oxide inhalation[J].Biophysics,2016,61(1):139-143.
[2] Al O S,Salama H,Al H M,et al.Effect of early adjunctive use of oral sildenafil and inhaled nitric oxide on the outcome of pulmonary hypertension in newborn infants.A feasibility study.[J].Journal of neonatal-perinatal medicine,2016,9(3):251.
[3] Bhatraju P,Crawford J,Hall M,et al.Inhaled nitric oxide:Current clinical concepts.[J].Nitric Oxide,2015,50:114-128.
[4] Albert M,Corsilli D,Williamson D R,et al.Comparison of inhaled milrinone,nitric oxide and prostacyclin in acute respiratory distress syndrome[J].World Journal of Critical Care Medicine,2017,6(1):74-78.
[5] Hajian B,Backer J D,Vos W,et al.Pulmonary vascular effects of pulsed inhaled nitric oxide in COPD patients with pulmonary hypertension[J].International Journal of Chronic Obstructive Pulmonary Disease,2016,11(Issue 1):1533-1541.
[6] Shah B K,Shah G S,Mishra O P.Mechanical ventilation in neonates:experience at a tertiary care center in eastern Nepal.[J].British Journal of Medicine&Medical Research,2015,5(1):75-80.
[7] Lee S,Yeo H J,Yoon S H,et al.Validity of Outcome Prediction Scoring Systems in Korean Patients with Severe Adult Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation Therapy[J].Journal of Korean Medical Science,2016,31(6):932-938.
[8] Migiyama Y,Hirosako S,Yamaguchi E,et al.A case of successful weaning from mechanical ventilation after inhaled tobramycin therapy for refractory Pseudomonas aeruginosa infection[J].Nihon Shuchu Chiryo Igakukai Zasshi,2015,22(2):122-126.
[9] Song W J,Kwon J W,Kim E J,et al.Clinical Application of Exhaled Nitric Oxide Measurements in a Korean Population[J].Allergy Asthma&Immunology Research,2015,7(1):3.
[10] Hoek R A S,Gommers D A M P J,Melles D C,et al.Inhalation Antibiotics in Ventilator-associated Pneumonia(VAP):,Drugs,Devices,and Evidence[J].Clinical Pulmonary Medicine,2016,23(4):163-168.
[11] Malaviya R,Gow A J,Francis M,et al.Radiation-Induced Lung Injury and Inflammation in Mice:Role of Inducible Nitric Oxide Synthase and Surfactant Protein D[J].Toxicological Sciences An Official Journal of the Society of Toxicology,2015,144(1):27-38.
[12] Soraisham A S,Harabor A,Shivananda S,et al.Trends and Variations in the Use of Inhaled Nitric Oxide in Preterm Infants in Canadian Neonatal Intensive Care Units[J].American Journal of Perinatology,2016,33(07):715-722.
[13] Watabe Y,Watabe Y,Kano Y,et al.Study about the Efficacy and Safety of Inhaled Nitric Oxide Therapy as Treatment for Persistent Pulmonary Hypertension of the Newborn[J].Dokkyo Journal of Medical Sciences,2015,42(2):71-75.
[14] Finer N N,Evans N.Inhaled nitric oxide for the preterm infant:evidence versus practice[J].Pediatrics,2015,135(4):754-756.
[15] Carey W A,Ellsworth M A,Harris M N.Inhaled Nitric Oxide Use in the Neonatal Intensive Care Unit:Rising Costs and the Need for a New Research Paradigm[J].Jama Pediatr,2016,170(7):639-640.
[16] Sokol G M,Konduri G G,Van Meurs K P.Inhaled nitric oxide therapy for pulmonary disorders of the term and preterm infant[J].Seminars in Perinatology,2016,40(6):356.
[17] Handley S C,Steinhorn R H,Hopper A O,et al.Inhaled nitric oxide use in preterm infants in California neonatal intensive care units[J].Journal of Perinatology,2016,36(8):635-639.
[18] Gaddam Bhoomaiah S,Rasiah S V.Outcomes of inhaled nitric oxide in preterm neonates–a five‐year experience in a tertiary neonatal centre[J]. Acta Paediatrica,2015,104(9):880-882.
[19] Lemke R P,Belik J,Giddins N G,et al.Clinical Experience in the Use of Inhaled Nitric Oxide in Infants with Pulmonary Hypertension[J].2016,3(5):295-300.
[20] Martusevich A K,Peretyagin S P,Soloveva A G,et al.Experimental investigation of some systemic effects of nitric oxide inhalation[J].Biophysics,2016,61(1):139-143.