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目的探讨吸入一氧化氮(iNO)治疗早产儿低氧性呼吸衰竭的疗效及安全性。方法将2007年3月至2010年3月本院收治的因呼吸窘迫综合征引起低氧性呼吸衰竭,且胎龄<34周的早产儿随机分为干预组(iNO组)和对照组。两组均采用基础治疗及机械通气等常规治疗。iNO组在常规治疗基础上加用NO吸入治疗,NO吸入浓度从5ppm开始,最高20ppm,持续吸入时间24～72h,同时动态监测主要血气指标,包括pH、PaO2、PaCO2、PaO2/FiO2、SaO2、动脉-肺泡血氧分压差[(A-a)PO2]以及氧合指数(OI)的变化。结果 iNO组(n=16)与对照组(n=19)比较,治疗后12、24、48h及72h血气指标明显改善(P均<0.05),其中24h最明显[pH(7.4±0.1)比(7.2±0.1),PaO2(68.7±10.1)mmHg比(51.6±11.3)mmHg,PaCO2(38.6±8.2)mmHg比(48.4±12.1)mmHg,PaO2/FiO2(206.8±32.5)mmHg比(165.2±22.7)mmHg,SaO2(0.93±0.07)比(0.81±0.09),(A-a)PO2(227.4±126.8)mmHg比(346.7±160.2)mmHg,OI(5.8±3.5)比(9.2±6.2)]。iNO组气道NO2浓度<1ppm,出血时间正常,死亡数及并发症的发生未增加。结论 iNO治疗早产儿低氧性呼吸衰竭能够显著改善氧合功能,纠正高碳酸血症和酸中毒,并未增加不良反应的发生。
Objective To investigate the efficacy and safety of inhaled nitric oxide (iNO) in the treatment of hypoxic respiratory failure in premature infants. Methods Hypoxic respiratory failure due to respiratory distress syndrome was induced in our hospital from March 2007 to March 2010. Premature infants <34 weeks old were randomly divided into intervention group (iNO group) and control group. Both groups were treated with conventional therapy such as basic therapy and mechanical ventilation. In the iNO group, NO inhalation was used on the basis of routine treatment. The inhalation concentration of NO started from 5ppm, the highest was 20ppm, the duration of inhalation was 24 ~ 72h. Meanwhile, the main blood gas indexes including pH, PaO2, PaCO2, PaO2 / FiO2, SaO2, Arterial - alveolar partial pressure difference [(Aa) PO2] and oxygenation index (OI) changes. Results Compared with the control group (n = 19), the blood gas indexes of iNO group (n = 16) were significantly improved at 12, 24, 48 and 72 hours after treatment (all P <0.05) (7.2 ± 0.1), PaO2 (68.7 ± 10.1) mmHg (51.6 ± 11.3) mmHg, PaCO2 (38.6 ± 8.2) mmHg and (48.4 ± 12.1) mmHg, PaO2 / FiO2 ), mmHg (0.93 ± 0.07), (Aa) PO2 (227.4 ± 126.8) mmHg and (346 ± ± 3.6) mmHg and 5.8 ± 3.5 (9.2 ± 6.2) iNO group airway NO2 concentration <1ppm, bleeding time is normal, the number of deaths and complications did not increase. Conclusion iNO treatment of hypoxic respiratory failure in preterm children can significantly improve oxygenation function, correct hypercapnia and acidosis, did not increase the incidence of adverse reactions.