Rao Shripada, Bartle David, Patole Sanjay
Department of Neonatal Paediatrics, KEM Hospital for Women, Bagot road, Subiaco, Perth 6008, Western Australia, Australia.
Expert Rev Cardiovasc Ther. 2010 Jun;8(6):845-62. doi: 10.1586/erc.09.186.
Persistent pulmonary hypertension of the newborn (PPHN) is a potentially life-threatening condition that is characterized by supra-systemic pulmonary vascular resistance causing right-to-left shunting through the ductus arteriosus and/or foramen ovale, leading to a vicious cycle of hypoxemia, acidosis and further pulmonary vasoconstriction. Advances in neonatology including surfactant instillation, high-frequency ventilation, extracorporeal membrane oxygenation and, most importantly, inhaled nitric oxide (INO), have revolutionized the management of PPHN. However, given that INO does not improve oxygenation in a significant proportion (30-40%) of cases, there is an urgent need to consider other therapeutic options for PPHN. The issue is more important for developing nations with a higher PPHN-related health burden and limited resources. This article discusses the evidence about INO in term and preterm neonates in brief, and focuses mainly on the potential alternative drugs in the management of PPHN.
新生儿持续性肺动脉高压（PPHN）是一种潜在的危及生命的病症，其特征是肺血管阻力超过体循环水平，导致血液通过动脉导管和/或卵圆孔发生右向左分流，进而引发低氧血症、酸中毒和进一步肺血管收缩的恶性循环。新生儿学的进展，包括肺表面活性物质的应用、高频通气、体外膜肺氧合，以及最重要的吸入一氧化氮（INO），彻底改变了PPHN的治疗方式。然而，鉴于INO在相当比例（30%-40%）的病例中并不能显著改善氧合，迫切需要考虑PPHN的其他治疗选择。对于PPHN相关健康负担较高且资源有限的发展中国家而言，这个问题更为重要。本文简要讨论了关于足月和早产新生儿使用INO的证据，并主要关注PPHN治疗中潜在的替代药物。
