摘要
研究目的:对新生儿持续肺动脉高压症(Persistent Pulmonary Hypertension of Newborn, PPHN)的住院治疗经过进行综合分析,比较并评价机械通气(Mechanical Ventilation, MV)包括常规机械通气(CMV)和高频振荡通气(HFOV)联合应用血管扩张剂与单纯药物治疗对PPHN 的临床疗效及其临床价值。研究方法:回顾性分析78 例PPHN 患儿住院治疗经过,按不同的治疗方法将受试患儿分为单纯药物治疗组18 例和常规机械通气治疗组(CMV 组)26 例以及高频振荡通气治疗组(HFOV 组)34 例;其中单纯药物治疗组为常规扩张血管药物治疗(多巴胺、妥拉苏林、硫酸镁等),机械通气组指在一般常规药物治疗的基础上同时予以机械通气治疗,部分机械通气患儿同时予以肺泡表面活性物质(PS)和一氧化氮吸入(iNO)治疗。同时对下列指标进行分析:1、临床经过:分析比较两组患儿的住院经过、临床疗效和预后、住院时间和住院费用、呼吸机拔管撤机时间以及并发症的发生情况等;2、血气分析:分别于治疗前、治疗后24 小时、48 小时、72 小时连续动态监测治疗期间患儿血气分析的变化,了解血液酸碱度(pH)、动脉血氧分压(PaO2)、二氧化碳分压(PCO2)、肺泡/动脉氧分压差(PA-aO2)、氧合指数(OI)、碱剩余(BE)等指标的改变,并指导临床治疗;3、影像学检查:以定期X 线胸片、彩色多普勒心脏超声检查等方法动态评价治疗效果;4、血管活性多肽的测定:放射免疫分析法测定治疗前后部分患儿血浆中血管活性多肽物质包括血管内皮素-1(Endothelin-1, ET-1)、心房利钠肽(Atrial Natriuretic Peptide, ANP)和降钙素基因相关肽(Calcitonin Gene Related Peptide, CGRP)等的变化及与临床病程的关系。对上述检测指标均通过统计学方法进行相应的统计学检验。结果1、临床疗效: 通过前后对比分析,治疗结果显示CMV 组和HFOV 组患儿治愈好转率分别为92.3%和91.2%,明显高于单纯药物治疗组的77 .8%(P<0.05)。在机械通气治疗组中,联合应用PS或iNO治疗者临床治愈好转率明显提高。平均住院时间机械通气组组患儿少于单纯药物治疗
Aim: To evaluate the value of mechanical ventilation including conventional mechanical ventilation (CMV) and high frequency oscillatory ventilation (HFOV) compared with vasodilator only on treatment of persistent pulmonary hypertension of newborn (PPHN). Method: Retrospective study on 78 cases of PPHN who were divided into three groups based on different treatments: 18 cases were in group A treated by vasodilator (dopamine, tolazoline, phentolamine or magnesium sulfate) only, 26 cases were in group B and treated by vasodilator plus CMV, 34 cases were in group C and treated by vasodilator plus HFOV. In group B and C there were some cases treated by pulmonary surfactant (PS) or inhaled nitric oxide (iNO) also. Several indexes including clinic outcomes, blood-gas analysis, radiologic and echocardiographic findings and vasoactive peptides as endothelin-1 (ET-1), atrial natriuretic peptide (ANP) and calcitonin-gene related peptide (CGRP) were observed. Results: There were more recovered cases in group B (92.3%) and group C (91.2%) than in group A (77.8%) (P<0.05), especially in those treated combined with PS (95.7%) or iNO(97.3%). Serial blood-gas analysis showed that cases in group B or C had better oxygenation indexes including pH, PaO2, PaCO2, PA-aO2, BE and OI than those in group A(P<0.05, P<0.01). Moreover, HFOV showed better oxygenation compared to CMV. Infants treated by mechanical ventilation combined with PS or iNO therapy had more improvements in oxygenation indexes. Vasoactive peptides ET-1, ANP and CGRP had quicker recovered tendencies in group B and group C than in group A (P<0.05,P<0.01). Conclusion: In this retrospective study we demonstrated that
mechanical ventilation especially HFOV combined with vasodilators had a more value functions in treatment of PPHN. Mechanical ventilation combined with PS or iNO therapy maybe the best choice in treatment of PPHN. Vasoactive peptide ET-1, ANP and CGRP could play important role in pathophysiologic developmental mechanism in PPHN and be a valuable index in judgement of outcome of PPHN clinically.
引文
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