影响一氧化氮吸入治疗新生儿持续肺动脉高压的预后危险因素分析
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摘要
目的探究影响NO(一氧化氮)吸入治疗PPHN(新生儿持续肺动脉高压)患儿预后的危险因素及防治策略。方法对2014年8月—2018年10月入住安庆市立医院NICU(新生儿重症监护室)采用NO吸入治疗的42例PPHN患儿的临床资料进行系统回顾性分析。根据预后情况将患儿分为治疗成功组(27例)和失败组(15例)。收集患儿性别、出生体重、胎龄、分娩方式、羊水有无污染、出生时有无窒息、有无宫内窘迫、PS(肺泡表面活性物质)的应用、入院时血气分析结果(pH值、BE值、PaO_2、PaCO_2)、血糖、血钙浓度、母亲年龄、肺动脉压力值、有无并发症、NO吸入时间、机械通气时间、机械通气模式等,通过单因素和多因素危险因素分析找出影响患儿预后的危险因素。结果单因素分析显示,成功组和失败组在早产、围产期异常、出生体重、应用PS(肺泡表面活性物质)、机械通气时间、NO吸入时间、有无并发症这些因素中差异有统计学意义(均P<0.05);logistic回归分析提示早产、应用PS、NO吸入时间、并发症是影响NO吸入治疗PPHN患儿预后的危险因素。结论早产、NO吸入时间短及出现并发症是影响NO吸入治疗PPHN患儿预后的独立危险因素,应用PS可改善NO吸入治疗PPHN患儿的预后。
Objective To investigate the risk factors and preventative measures for inhaled nitric oxide in persistent pulmonary hypertension of newborn(PPHN). Methods A retrospective study was conducted at the neonatal department of the Anqing Municipal Hospital in 42 infants with persistent pulmonary hypertension treated by inhaled nitric oxide from August 2014 to October 2018. They were divided into two groups, namely 27 patients with good prognosis and 15 patients with poor prognosis according to the prognosis of patients. Analysis of factors including gender, birth weight, gestational age, delivery way, amniotic fluid pollution, history of suffocation, fetal distress, use of pulmonary surfactant and complications, immediate arterial blood for neonatal asphyxia(the pH value, the BE value, PaO_2, PaCO_2), blood sugar level, blood calcium, age of mother, pulmonary artery wedge pressure, time of mechanical ventilation, and time of inhaled nitric oxide, etc. The data were compared by univariate and multivariate logistic regression analysis. Results Univariate analysis showed that preterm delivery, fetal distress, weight, time of mechanical ventilation, time of inhaled nitric oxide, use of pulmonary surfactant and complications were the risk factors(P<0.05). Logistic regression analysis showed that preterm delivery, time of inhaled nitric oxide, complications and use of pulmonary surfactant were the main risk factors. Conclusion Patients with premature delivery, time of inhaled nitric oxide and complications with persistent pulmonary arterial hypertension were treated by inhaled NO had poor outcomes. The application of pulmonary surfactant can improve the outcome.
Objective To investigate the risk factors and preventative measures for inhaled nitric oxide in persistent pulmonary hypertension of newborn(PPHN). Methods A retrospective study was conducted at the neonatal department of the Anqing Municipal Hospital in 42 infants with persistent pulmonary hypertension treated by inhaled nitric oxide from August 2014 to October 2018. They were divided into two groups, namely 27 patients with good prognosis and 15 patients with poor prognosis according to the prognosis of patients. Analysis of factors including gender, birth weight, gestational age, delivery way, amniotic fluid pollution, history of suffocation, fetal distress, use of pulmonary surfactant and complications, immediate arterial blood for neonatal asphyxia(the pH value, the BE value, PaO_2, PaCO_2), blood sugar level, blood calcium, age of mother, pulmonary artery wedge pressure, time of mechanical ventilation, and time of inhaled nitric oxide, etc. The data were compared by univariate and multivariate logistic regression analysis. Results Univariate analysis showed that preterm delivery, fetal distress, weight, time of mechanical ventilation, time of inhaled nitric oxide, use of pulmonary surfactant and complications were the risk factors(P<0.05). Logistic regression analysis showed that preterm delivery, time of inhaled nitric oxide, complications and use of pulmonary surfactant were the main risk factors. Conclusion Patients with premature delivery, time of inhaled nitric oxide and complications with persistent pulmonary arterial hypertension were treated by inhaled NO had poor outcomes. The application of pulmonary surfactant can improve the outcome.
引文
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[13] 燕超,李振光.吸入不同浓度一氧化氮治疗新生儿持续性肺动脉高压的疗效及安全性分析[J].中国妇幼保健,2018,33(4):832-835.
[14] 李小燕,王慧琴,柴竹青,等.机械通气治疗新生儿呼吸窘迫综合征疗效观察[J].安徽医药,2016,20(5):934-936.
[15] 刘宝俊,王宏伟,薛爱梅,等.高频震荡通气在新生儿呼吸窘迫综合征中应用[J].中华实用诊断与治疗杂志,2016,30(2):177-179.
[16] 陈一欢,蔡成,龚小慧,等.一氧化氮吸入联合高频振荡通气治疗新生儿持续肺动脉高压疗效分析[J].中国新生儿科杂志,2015,30(2):117-120.
[17] 霍汝亚寒,陈晶,刘恒.高频震荡通气联合肺泡表面活性物质治疗新生儿呼吸窘迫综合征[J].临床肺科杂志,2016,21(8):1535-1537.
[18] 范雪爱.NCPAP联合肺表面活性物质、硫酸镁治疗新生儿肺动脉高压30例[J].陕西医学杂志,2015,44(5):534-536.
[19] 张丽美,曹玲云.固尔苏治疗新生儿肺部病变继发持续性肺动脉高压疗效分析[J].浙江临床医学,2016,18(6):1067-1068.
[20] 刘东海,高红霞,易彬,等.吸入一氧化氮治疗新生儿低氧性呼吸衰竭临床随机对照研究[J].中国新生儿科杂志,2016,31(3):182-188.
[21] 穆宣壑.西地那非联合一氧化氮吸入治疗新生儿持续性肺动脉高压的效果研究[J].中国医学前沿杂志(电子版),2017,9(6):135-139.
[2] 华国伟.一氧化氮吸入疗法治疗新生儿持续肺动脉高血压的疗效探讨[J].中外医疗,2015,34(7):85-87.
[3] 中华医学会儿科学分会新生儿学组,《中华儿科杂志》编辑委员会.新生儿肺动脉高压诊治专家共识[J].中华儿科杂志,2017,55(3):163-167.
[4] NAIR J,LAKSHMINRUSIMHA S.Update on PPHN:mechanisms and treatment[J].Semin Perinatol,2014,38(2):78-91.
[5] 陈爱萍,李志飞.西地那非联合高频振荡通气治疗新生儿持续肺动脉高压的疗效[J].中国妇幼健康研究,2015,26(4):727-728.
[6] HUNT J M,RISBANO M G,MESSENGER J C,et al.Timed response inhaled nitric oxide in pulmonary hypertension[J].Pulm Circ,2014,4(1):103-109.
[7] 车晓晴.机械通气联合吸入一氧化氮对新生儿重度呼吸衰竭呼吸功能指标及动脉血气指标的影响[J].医药论坛杂志,2017,38(3):96-98.
[8] 马金凤,张健,傅燕娜,等.常频通气联合一氧化氮治疗新生儿持续肺动脉高压[J].中华全科医学,2014,12(9):1417-1418,1421.
[9] 朱兴旺,朱小冰.吸入一氧化氮治疗新生儿持续性肺动脉高压研究进展[J].中国新生儿科杂志,2015,30(3):236-240.
[10] 刘学丹,李晓春.吸入一氧化氮治疗新生儿持续性肺动脉高压的临床进展[J].安徽医学,2014,35(11):1618-1620.
[11] BARRINGTON K J,FINER N.Inhaled nitric oxide for respiratory failure in preterm infants[J].Cochrane Database Syst Rev,2010,12:CD000509.
[12] 吴新萍,卜笃翰,王磊,等.不同血管扩张剂联合应用治疗新生儿持续肺动脉高压的临床观察[J].医学理论与实践,2016,29(4):439-441.
[13] 燕超,李振光.吸入不同浓度一氧化氮治疗新生儿持续性肺动脉高压的疗效及安全性分析[J].中国妇幼保健,2018,33(4):832-835.
[14] 李小燕,王慧琴,柴竹青,等.机械通气治疗新生儿呼吸窘迫综合征疗效观察[J].安徽医药,2016,20(5):934-936.
[15] 刘宝俊,王宏伟,薛爱梅,等.高频震荡通气在新生儿呼吸窘迫综合征中应用[J].中华实用诊断与治疗杂志,2016,30(2):177-179.
[16] 陈一欢,蔡成,龚小慧,等.一氧化氮吸入联合高频振荡通气治疗新生儿持续肺动脉高压疗效分析[J].中国新生儿科杂志,2015,30(2):117-120.
[17] 霍汝亚寒,陈晶,刘恒.高频震荡通气联合肺泡表面活性物质治疗新生儿呼吸窘迫综合征[J].临床肺科杂志,2016,21(8):1535-1537.
[18] 范雪爱.NCPAP联合肺表面活性物质、硫酸镁治疗新生儿肺动脉高压30例[J].陕西医学杂志,2015,44(5):534-536.
[19] 张丽美,曹玲云.固尔苏治疗新生儿肺部病变继发持续性肺动脉高压疗效分析[J].浙江临床医学,2016,18(6):1067-1068.
[20] 刘东海,高红霞,易彬,等.吸入一氧化氮治疗新生儿低氧性呼吸衰竭临床随机对照研究[J].中国新生儿科杂志,2016,31(3):182-188.
[21] 穆宣壑.西地那非联合一氧化氮吸入治疗新生儿持续性肺动脉高压的效果研究[J].中国医学前沿杂志(电子版),2017,9(6):135-139.