Hoehn T, Krause M F
Department of Neonatology, Charité Campus Virchow Klinikum, Humboldt University, Berlin, Germany.
Drugs. 2001;61(1):27-39. doi: 10.2165/00003495-200161010-00004.
Inhaled nitric oxide (iNO) has emerged as a promising therapeutic agent in the treatment of persistent pulmonary hypertension of the newborn. Several theories exist regarding causes of both response and nonresponse to iNO. Clinical trials differentiate disease entities (primary vs secondary persistent pulmonary hypertension associated with meconium aspiration syndrome, pneumonia or congenital diaphragmatic hernia) and their specific response rates. iNO combined with high-frequency ventilation appears to be superior to inhalation of nitric oxide (NO) during conventional ventilation. Little is known regarding the role of the degree of lung expansion and its modification -- no matter what mode of ventilation is applied. Gestational age plays an important role in relation to the potential adverse effects of NO. Of particular concern in the premature neonate is the effect of NO on bleeding time and the inhibition of platelet aggregation. Those potentially hazardous effects need to be carefully weighed against early intervention with iNO at a comparably low oxygenation index in order to prevent the vicious cycle of hypoxaemia and subsequent increased right-to-left shunting. Further studies are required to determine the optimal timing, mode of delivery and mode of ventilation used with iNO therapy in order to optimise the response of premature and term neonates.
吸入一氧化氮（iNO）已成为治疗新生儿持续性肺动脉高压的一种有前景的治疗药物。关于对iNO有反应和无反应的原因存在几种理论。临床试验区分了疾病实体（与胎粪吸入综合征、肺炎或先天性膈疝相关的原发性与继发性持续性肺动脉高压）及其特定的反应率。iNO联合高频通气似乎优于传统通气时吸入一氧化氮（NO）。关于肺扩张程度及其改变的作用知之甚少——无论采用何种通气模式。胎龄在NO的潜在不良反应方面起着重要作用。早产儿特别值得关注的是NO对出血时间的影响以及对血小板聚集的抑制作用。需要仔细权衡这些潜在的有害影响与在相对较低的氧合指数下尽早使用iNO进行干预，以防止低氧血症的恶性循环以及随后右向左分流增加。需要进一步研究以确定iNO治疗的最佳时机、给药方式和通气模式，以优化早产儿和足月儿的反应。
