Sadiq H Farouk, Mantych Gregory, Benawra Raghbir S, Devaskar Uday P, Hocker James R
Department of Pediatrics, Saint Louis University, Cardinal Glennon Children's Hospital, St. Louis, MO 63104, USA.
J Perinatol. 2003 Mar;23(2):98-103. doi: 10.1038/sj.jp.7210878.
Inhaled nitric oxide (iNO) improves oxygenation and reduces the need for extracorporeal membrane oxygenation in infants with severe persistent pulmonary hypertension of the newborn (PPHN). The effectiveness of iNO in the treatment of moderate PPHN has not been adequately defined. We therefore conducted a randomized, prospective multicenter study to assess whether iNO in patients with moderate PPHN would improve arterial p(a)O(2), prevent progression to severe PPHN, and improve outcomes.
Infants > or = 34 weeks gestation with moderate pulmonary hypertension (alveolar-arterial oxygen gradient (AaDO(2)) 500-599 Torr) were randomly assigned to continue standard medical therapy (control group) or standard medical therapy plus iNO (iNO group). For each patient in the iNO group, iNO concentration was increased in steps of 10-20 ppm every 30 minutes until there was no further improvement in arterial p(a)O(2). This concentration of iNO was then maintained while all other ventilatory support, including inspired oxygen concentration, was weaned according to a predefined protocol.
In all, 27 of 40 control patients (58%) compared to six of 40 infants (15%) in the iNO group failed assigned therapy and developed severe PPHN (p<0.0005). Arterial p(a)O(2) improved from 112+/-48 to 133+/-100 (p=0.132) in control infants compared to an increase from 101+/-29 to 208+/-118 (p<0.0005) in iNO-treated patients. For the first 36 hours after study, entry AaDO(2) levels and ventilatory support were significantly lower in iNO-treated infants compared to control patients.
In patients with moderate PPHN, treatment with iNO improves arterial p(a)O(2), reduces the amount of ventilatory support needed, and prevents progression to severe PPHN.
吸入一氧化氮(iNO)可改善新生儿重症持续性肺动脉高压(PPHN)患儿的氧合,并减少体外膜肺氧合的需求。iNO治疗中度PPHN的有效性尚未得到充分明确。因此,我们开展了一项随机、前瞻性多中心研究,以评估iNO对中度PPHN患者动脉血氧分压(p(a)O(2))的改善情况、预防病情进展为重度PPHN以及改善预后的效果。
妊娠≥34周、患有中度肺动脉高压(肺泡-动脉血氧梯度(AaDO(2))为500 - 599托)的婴儿被随机分配继续接受标准药物治疗(对照组)或标准药物治疗加iNO(iNO组)。对于iNO组的每位患者,iNO浓度每30分钟以10 - 20 ppm的步长增加,直至动脉p(a)O(2)不再进一步改善。然后维持该iNO浓度,同时根据预定义方案逐步减少包括吸入氧浓度在内的所有其他通气支持。
总体而言,对照组40例患者中有27例(58%)治疗失败并发展为重度PPHN,而iNO组40例婴儿中有6例(15%)出现这种情况(p < 0.0005)。对照组婴儿的动脉p(a)O(2)从112±48升至133±百(p = 0.132),而接受iNO治疗的患者则从101±29升至208±118(p < 0.0005)。在研究后的前36小时,与对照组患者相比,接受iNO治疗的婴儿的初始AaDO(2)水平和通气支持显著更低。
对于中度PPHN患者,iNO治疗可改善动脉p(a)O(2),减少所需的通气支持量,并预防病情进展为重度PPHN。